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NPI Code Detail

MEDICARE: MARY JAN GREMILLION LCSW

MEDICARE: MARY JAN GREMILLION 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
1104100000XSocial Worker6601LA

General Provider Information

NPI Number : 1972817906
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JAN GREMILLION LCSW
Provider Business Mailing Address
First Line : 5151 EVERETT LN
Second Line : # A
City : BATON ROUGE
State : LA
Zip : 70809-3693
Country : US
Telephone Number : 225-505-5745
Fax Number :
Provider Business Practice Location Address
First Line : 1900 S ACADIAN THRUWAY
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-1665
Country : US
Telephone Number : 225-336-8708
Fax Number : 225-336-8703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2010
Last Update Date : 08/02/2010

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Directions to “ MARY JAN GREMILLION LCSW” Practice Location

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