Provider Demographics
NPI:1639200827
Name:MATHERNE, MARJORIE BLOCK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:BLOCK
Last Name:MATHERNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 NORTH ACADIA ROAD,
Mailing Address - Street 2:SUITE 201
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4847
Mailing Address - Country:US
Mailing Address - Phone:985-493-9304
Mailing Address - Fax:985-493-9305
Practice Address - Street 1:604 N ACADIA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-493-9304
Practice Address - Fax:985-493-9305
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health