MEDICARE: RENEE RICHARDS LCSW 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

General Provider Information

NPI Number	:	1417427246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEE RICHARDS LCSW LLC

Provider Business Mailing Address
First Line	:	1405 W PINHOOK RD STE 106A
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3100
Country	:	US
Telephone Number	:	337-287-9075
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 W PINHOOK RD STE 106A
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3100
Country	:	US
Telephone Number	:	337-287-9075
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RENEE RICHARDS
Credential	:
Telephone Number	:	337-287-9075

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	12/05/2018

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