Provider Demographics
NPI:1225428188
Name:NEALY, JOHN E SR (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:NEALY
Suffix:SR
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 1:4615 GOVERNMENT ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5922
Mailing Address - Country:US
Mailing Address - Phone:225-925-1906
Mailing Address - Fax:225-925-1987
Practice Address - Street 1:4615 GOVERNMENT ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5922
Practice Address - Country:US
Practice Address - Phone:225-925-1906
Practice Address - Fax:225-925-1987
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA93581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical