Provider Demographics
NPI:1003818311
Name:MATHEWS, SANDRA S (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GREEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2719
Mailing Address - Country:US
Mailing Address - Phone:337-298-5218
Mailing Address - Fax:337-289-6944
Practice Address - Street 1:218 RUE LOUIS XIV
Practice Address - Street 2:STE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5766
Practice Address - Country:US
Practice Address - Phone:337-988-1271
Practice Address - Fax:337-988-1272
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1591122Medicaid
LA256245OtherCOMPSYCH
LA5X191Medicare ID - Type UnspecifiedMEDICARE