Basic Information
| Provider Information | |||||||||
| NPI: | 1528258563 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORNE | ||||||||
| FirstName: | HEATH | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, GSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3708 LOYOLA DR APT 113 | ||||||||
| Address2: | |||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700657717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044006208 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2121 RIDGELAKE DR | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700012080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048385002 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 8775 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.