MEDICARE: PAMELA T. MONG CLINICAL SOCIAL WORK ASSOCIATES LLC

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	972	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619991825	OTHER	LA	NPI

General Provider Information

NPI Number	:	1194951681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMELA T. MONG CLINICAL SOCIAL WORK ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	9456 JEFFERSON HWY
Second Line	:	SUITE B
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-2883
Country	:	US
Telephone Number	:	225-293-2255
Fax Number	:	225-292-1900

Provider Business Practice Location Address
First Line	:	9456 JEFFERSON HWY
Second Line	:	SUITE B
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-2883
Country	:	US
Telephone Number	:	225-293-2255
Fax Number	:	225-292-1900

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MS. PAMELA T. MONG
Credential	:	LCSW
Telephone Number	:	225-293-2255

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	06/10/2009

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