Basic Information
| Provider Information | |||||||||
| NPI: | 1487040978 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROL N. FONTENOT LCSW LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6744 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701746744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043097844 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 HOUMA BLVD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044572906 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2015 | ||||||||
| LastUpdateDate: | 04/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | FONTENOT | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | N. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5044572906 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3317 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.