1457845406 NPI number — LOU IRWIN LCSW LLC

Table of content: (NPI 1457845406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457845406 NPI number — LOU IRWIN LCSW LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOU IRWIN LCSW LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457845406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 56266
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70055-6266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-837-7474
Provider Business Mailing Address Fax Number:
504-828-8814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
804 N CAUSEWAY BLVD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70001-5364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-837-7474
Provider Business Practice Location Address Fax Number:
504-828-8814
Provider Enumeration Date:
06/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
IRWIN
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
CLINT
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER--SOLE MEMBER
Authorized Official Telephone Number:
504-837-7474

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  1593 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1593 . This is a "LICENSED CLINICAL SOCIAL WORKER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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