Provider Demographics
NPI:1497220404
Name:ABBOTT, RUBY DARLENE (LCSW, BACS)
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:DARLENE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:LCSW, BACS
Other - Prefix:MRS
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, BACS
Mailing Address - Street 1:33849 CANE MARKET RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-4015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10425 PLAZA AMERICANA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8188
Practice Address - Country:US
Practice Address - Phone:225-810-4719
Practice Address - Fax:225-810-4722
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical