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NPI Code Detail

MEDICARE: MRS. CARMEN BERGERON FALGOUT LCSW

MEDICARE: MRS. CARMEN BERGERON FALGOUT LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2950LA

General Provider Information

NPI Number : 1033137575
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARMEN BERGERON FALGOUT LCSW
Provider Business Mailing Address
First Line : 100 COULEE SHORE DR
Second Line :
City : LAFAYETTE
State : LA
Zip : 70503-3021
Country : US
Telephone Number : 337-237-0036
Fax Number : 337-237-0566
Provider Business Practice Location Address
First Line : 100 COULEE SHORE DR
Second Line :
City : LAFAYETTE
State : LA
Zip : 70503-3021
Country : US
Telephone Number : 337-237-0036
Fax Number : 337-237-0566
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 07/08/2007

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