MEDICARE: MR. MICHAEL SUNSERI 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	1041C0700X	Clinical Social Worker	3354	LA

General Provider Information

NPI Number	:	1912071499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL SUNSERI LCSW

Provider Business Mailing Address
First Line	:	10819 RIDGELY RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3232
Country	:	US
Telephone Number	:	225-802-5407
Fax Number	:	225-952-9214

Provider Business Practice Location Address
First Line	:	4521 JAMESTOWN AVE
Second Line	:	#2
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-3234
Country	:	US
Telephone Number	:	225-952-9210
Fax Number	:	225-952-9214

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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