Healthcare Provider Details

I. General information

NPI: 1932954666
Provider Name (Legal Business Name): LISA H TROMBETTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 MURPHY ST
SHREVEPORT LA
71103-2549
US

IV. Provider business mailing address

7337 CAPISTRANO DR
SHREVEPORT LA
71105-5011
US

V. Phone/Fax

Practice location:
  • Phone: 318-208-7400
  • Fax: 318-603-6883
Mailing address:
  • Phone: 318-208-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number4132
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: