Provider Demographics
NPI:1093982787
Name:BROUSSARD, CARMEN DUPRE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:DUPRE
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:NAPOLEONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70390-8728
Mailing Address - Country:US
Mailing Address - Phone:985-688-1240
Mailing Address - Fax:
Practice Address - Street 1:3965 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390-8728
Practice Address - Country:US
Practice Address - Phone:985-688-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA808103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool