Provider Demographics
NPI:1619178415
Name:GALATAS, DARRELL L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:L
Last Name:GALATAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 OCTAVIA DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1025
Mailing Address - Country:US
Mailing Address - Phone:985-630-3894
Mailing Address - Fax:985-249-5853
Practice Address - Street 1:5001 HIGHWAY 190 EAST SERVICE RD STE A1
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4998
Practice Address - Country:US
Practice Address - Phone:985-630-3894
Practice Address - Fax:985-249-5853
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA82441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3C512Medicare PIN