Healthcare Provider Details

I. General information

NPI: 1255871596
Provider Name (Legal Business Name): MARY KATHERINE VERBERNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATHERINE SCHILLINGS

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27124 HIGHWAY 42
SPRINGFIELD LA
70462-7979
US

IV. Provider business mailing address

PO BOX 395
CLINTON LA
70722-0395
US

V. Phone/Fax

Practice location:
  • Phone: 225-395-8022
  • Fax: 225-395-8023
Mailing address:
  • Phone: 225-683-5292
  • Fax: 225-683-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11807
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: