MEDICARE: MS. MARRENE WILLIAMS BEATTY LCSW-BACS

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	1350	LA

General Provider Information

NPI Number	:	1578805057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARRENE WILLIAMS BEATTY LCSW-BACS

Provider Business Mailing Address
First Line	:	130 ROBINHOOD DR
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-5754
Country	:	US
Telephone Number	:	985-543-4800
Fax Number	:	985-543-4817

Provider Business Practice Location Address
First Line	:	1951 FLORIDA AVE SW STE D&E
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4947
Country	:	US
Telephone Number	:	985-543-4800
Fax Number	:	985-543-4817

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

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	08/04/2023

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