Provider Demographics
NPI:1326131590
Name:BREITHAUPT, ROBIN G (LCSW,DCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:G
Last Name:BREITHAUPT
Suffix:
Gender:F
Credentials:LCSW,DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PIERREMONT RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2044
Mailing Address - Country:US
Mailing Address - Phone:318-629-5036
Mailing Address - Fax:
Practice Address - Street 1:900 PIERREMONT RD
Practice Address - Street 2:SUITE 214
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2044
Practice Address - Country:US
Practice Address - Phone:318-629-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2088104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH0557OtherBLUE CROSS PROVIDER NUMBE
LA2088OtherSOCIAL WORKERS LICENSE
LAH0557OtherBLUE CROSS PROVIDER NUMBE