Provider Demographics
NPI:1295841765
Name:SWETLIK, SALOME DOROTHY (MSW)
Entity Type:Individual
Prefix:MS
First Name:SALOME
Middle Name:DOROTHY
Last Name:SWETLIK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BON TEMPS ROULE
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2566
Mailing Address - Country:US
Mailing Address - Phone:985-845-0563
Mailing Address - Fax:985-845-0563
Practice Address - Street 1:1539 METAIRIE RD
Practice Address - Street 2:STE C
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3900
Practice Address - Country:US
Practice Address - Phone:504-837-0560
Practice Address - Fax:985-845-0563
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S213Medicare PIN