MEDICARE: MS. LAURA MARIE MYERS MSW

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
1	1041C0700X	Clinical Social Worker	1179	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21531	OTHER		BLUE CROSS

General Provider Information

NPI Number	:	1073657839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA MARIE MYERS MSW

Provider Business Mailing Address
First Line	:	2901 RIDGELAKE DRIVE
Second Line	:	SUITE 116
City	:	METAIRIE
State	:	LA
Zip	:	70002-4946
Country	:	US
Telephone Number	:	504-833-1869
Fax Number	:	504-834-1870

Provider Business Practice Location Address
First Line	:	2901 RIDGELAKE DRIVE
Second Line	:	SUITE 116
City	:	METAIRIE
State	:	LA
Zip	:	70002-4946
Country	:	US
Telephone Number	:	504-833-1869
Fax Number	:	504-834-1870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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