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NPI Code Detail

MEDICARE: SAMANTHA NICKENS LMSW

MEDICARE: SAMANTHA NICKENS LMSW
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
1104100000XSocial Worker15835LA

General Provider Information

NPI Number : 1447843925
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA NICKENS LMSW
Provider Business Mailing Address
First Line : 2471 LOUISIANA AVE
Second Line :
City : LUTCHER
State : LA
Zip : 70071-5413
Country : US
Telephone Number : 225-258-6103
Fax Number :
Provider Business Practice Location Address
First Line : 2471 LOUISIANA AVE
Second Line :
City : LUTCHER
State : LA
Zip : 70071-5413
Country : US
Telephone Number : 225-258-6103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2021
Last Update Date : 02/16/2021

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Directions to “ SAMANTHA NICKENS LMSW” Practice Location

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