Provider Demographics
NPI:1558138628
Name:DEPRIMO, JACOB P (LCSW)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:P
Last Name:DEPRIMO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-743-2445
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:1024 E ASCENSION COMPLEX BLVD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4263
Practice Address - Country:US
Practice Address - Phone:225-743-2445
Practice Address - Fax:225-450-1150
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA117501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical