MEDICARE: ROBELOT & LEBOURGEOIS 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	251S00000X	Community/Behavioral Health Agency	3422	LA

General Provider Information

NPI Number	:	1659677391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBELOT & LEBOURGEOIS LLC

Provider Business Mailing Address
First Line	:	1056 E WORTHY ST
Second Line	:	SUITE E
City	:	GONZALES
State	:	LA
Zip	:	70737-4369
Country	:	US
Telephone Number	:	225-603-3135
Fax Number	:

Provider Business Practice Location Address
First Line	:	1056 E WORTHY ST
Second Line	:	SUITE E
City	:	GONZALES
State	:	LA
Zip	:	70737-4369
Country	:	US
Telephone Number	:	225-603-3135
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MR. ALFRED LOUIS ROBELOT JR.
Credential	:	LCSW
Telephone Number	:	225-603-3135

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	02/04/2011

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