Provider Demographics
NPI:1639870157
Name:BROUSSARD, LAMYA (LSW, MSS, MLSP)
Entity Type:Individual
Prefix:MS
First Name:LAMYA
Middle Name:
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:LSW, MSS, MLSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 PRESIDENTIAL BLVD STE W10
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1205
Mailing Address - Country:US
Mailing Address - Phone:267-689-7877
Mailing Address - Fax:
Practice Address - Street 1:191 PRESIDENTIAL BLVD STE W10
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1205
Practice Address - Country:US
Practice Address - Phone:267-689-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker