Provider Demographics
NPI:1073297701
Name:MALBROUGH, LAJEANNE (CSW)
Entity Type:Individual
Prefix:
First Name:LAJEANNE
Middle Name:
Last Name:MALBROUGH
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0623
Mailing Address - Country:US
Mailing Address - Phone:337-412-1530
Mailing Address - Fax:
Practice Address - Street 1:808 MILLER RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0623
Practice Address - Country:US
Practice Address - Phone:337-412-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker