1568528958 NPI number — MISS CHARLOTTE YVETTE DEGREE BSW, RSW

Table of content: MISS CHARLOTTE YVETTE DEGREE BSW, RSW (NPI 1568528958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568528958 NPI number — MISS CHARLOTTE YVETTE DEGREE BSW, RSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGREE
Provider First Name:
CHARLOTTE
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BSW, RSW
Provider Gender Code:
F

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:
1568528958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 W ESPLANADE AVE S
Provider Second Line Business Mailing Address:
SUITE 213
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70002-7406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-838-5716
Provider Business Mailing Address Fax Number:
504-838-5714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 RIDGELAKE DR
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70001-2080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-832-5123
Provider Business Practice Location Address Fax Number:
504-838-5714
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  9409 , 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)





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