Basic Information
Provider Information | |||||||||
NPI: | 1508200643 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GAUBERT | ||||||||
FirstName: | DANIELLE | ||||||||
MiddleName: | RENEE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GAUBERT | ||||||||
OtherFirstName: | RENEE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LCSW | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 2909 DIVISION ST | ||||||||
Address2: | STE. C | ||||||||
City: | METAIRIE | ||||||||
State: | LA | ||||||||
PostalCode: | 70002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5043155663 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2626 CHARLES DR | ||||||||
Address2: |   | ||||||||
City: | CHALMETTE | ||||||||
State: | LA | ||||||||
PostalCode: | 700433779 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5042784006 | ||||||||
FaxNumber: | 5042784007 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/19/2013 | ||||||||
LastUpdateDate: | 07/20/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/20/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X |   |   | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 104100000X | 11185 | LA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.