Provider Demographics
NPI:1154090421
Name:GAGE, RATEAH (LCSW)
Entity Type:Individual
Prefix:
First Name:RATEAH
Middle Name:
Last Name:GAGE
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 1:14635 RHONDA AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-7445
Mailing Address - Country:US
Mailing Address - Phone:337-207-8026
Mailing Address - Fax:
Practice Address - Street 1:2020 E 70TH ST STE 301
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5332
Practice Address - Country:US
Practice Address - Phone:318-553-5591
Practice Address - Fax:318-553-5592
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA114041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical