Provider Demographics
NPI:1013028216
Name:SUTTON, JESSE DEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:DEAN
Last Name:SUTTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6625
Mailing Address - Country:US
Mailing Address - Phone:504-914-1966
Mailing Address - Fax:504-348-1154
Practice Address - Street 1:4905 WICHERS DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3028
Practice Address - Country:US
Practice Address - Phone:504-340-3248
Practice Address - Fax:504-348-1154
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA73161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical