Provider Demographics
NPI:1336655141
Name:TYSON, MARGUERITE MARIE (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:MARIE
Last Name:TYSON
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 CANAL ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5878
Mailing Address - Country:US
Mailing Address - Phone:504-483-9883
Mailing Address - Fax:504-483-9082
Practice Address - Street 1:1035 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5913
Practice Address - Country:US
Practice Address - Phone:504-308-3501
Practice Address - Fax:504-301-0836
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
LA146721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA171M00000XMedicaid