Basic Information
| Provider Information | |||||||||
| NPI: | 1770954232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | RANI | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JOSEPH | ||||||||
| OtherFirstName: | RANI | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2150 GENERAL PERSHING STREET | ||||||||
| Address2: | |||||||||
| City: | MANDEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856745155 | ||||||||
| FaxNumber: | 9856745156 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 ASBURY DR | ||||||||
| Address2: | |||||||||
| City: | MANDEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704711842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856745155 | ||||||||
| FaxNumber: | 9856745156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2015 | ||||||||
| LastUpdateDate: | 12/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | 12291 | LA | N | Other Service Providers | Case Manager/Care Coordinator | 104100000X | 12291 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.