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General NPI Number Information
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NPI Number | 1881975324
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Entity Type | Organization
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Legal Business Name | THE JURON GROUP
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 4401 N I 10 SERVICE RD W SUITE 104
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City | METAIRIE
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State | LA
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Zip | 70006-6692
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Country | US
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Telephone | 504-454-8400
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Fax | 504-454-8401
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Provider Business Mailing Address
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Address Line | 4401 N I 10 SERVICE RD W SUITE 104
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City | METAIRIE
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State | LA
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Zip | 70006-6692
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Country | US
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Telephone | 504-454-8400
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Fax | 504-454-8401
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MARLENE M. JURON
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Credential | LCSW
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Telephone | 504-454-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11274
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License Number State | LA
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