Provider Demographics
NPI:1336681071
Name:DARBY, JEROME LAVETTE (MSW)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:LAVETTE
Last Name:DARBY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 DANBURY CT
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-3100
Mailing Address - Country:US
Mailing Address - Phone:318-230-1369
Mailing Address - Fax:
Practice Address - Street 1:351 W 79TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-4819
Practice Address - Country:US
Practice Address - Phone:318-688-8190
Practice Address - Fax:318-688-8193
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health