Healthcare Provider Details

I. General information

NPI: 1659747798
Provider Name (Legal Business Name): STACY MARIE DILIBERTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3196 TERRACE AVE.
SLIDELL LA
70458
US

IV. Provider business mailing address

PO BOX 6744
NEW ORLEANS LA
70174-6744
US

V. Phone/Fax

Practice location:
  • Phone: 985-788-7822
  • Fax: 504-309-7845
Mailing address:
  • Phone: 504-309-7844
  • Fax: 504-309-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9492
License Number StateLA

VIII. Authorized Official

Name: STACY MARIE DILIBERTO
Title or Position: LCSW/OWNER
Credential: LCSW
Phone: 504-985-7822