MEDICARE: MRS. PATTI GENNARDO LANIER LCSW

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	104100000X	Social Worker	3729	LA

General Provider Information

NPI Number	:	1780834986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATTI GENNARDO LANIER LCSW

Provider Business Mailing Address
First Line	:	47285 RUFUS BANKSTON RD
Second Line	:
City	:	TICKFAW
State	:	LA
Zip	:	70466-4503
Country	:	US
Telephone Number	:	985-507-1368
Fax Number	:	985-345-1157

Provider Business Practice Location Address
First Line	:	47285 RUFUS BANKSTON RD
Second Line	:
City	:	TICKFAW
State	:	LA
Zip	:	70466-4503
Country	:	US
Telephone Number	:	985-507-1368
Fax Number	:	985-345-1157

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

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/24/2008

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