Provider Demographics
NPI:1558548271
Name:BROYLES, BARBARA BENNETT (LCSW 3462)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:BENNETT
Last Name:BROYLES
Suffix:
Gender:F
Credentials:LCSW 3462
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:FAITH BENNETT
Other - Last Name:BROYLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8017 JEFFERSON HWY
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1681
Mailing Address - Country:US
Mailing Address - Phone:225-924-3351
Mailing Address - Fax:
Practice Address - Street 1:8017 JEFFERSON HWY
Practice Address - Street 2:SUITE C-1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1681
Practice Address - Country:US
Practice Address - Phone:225-924-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T803Medicare PIN