Healthcare Provider Details

I. General information

NPI: 1780834986
Provider Name (Legal Business Name): PATTI GENNARDO LANIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47285 RUFUS BANKSTON RD
TICKFAW LA
70466-4503
US

IV. Provider business mailing address

47285 RUFUS BANKSTON RD
TICKFAW LA
70466-4503
US

V. Phone/Fax

Practice location:
  • Phone: 985-507-1368
  • Fax: 985-345-1157
Mailing address:
  • Phone: 985-507-1368
  • Fax: 985-345-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3729
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: