Provider Demographics
NPI:1649583303
Name:BELSOM, CHARLES W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:BELSOM
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 1:220 TOPAZ ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2634
Mailing Address - Country:US
Mailing Address - Phone:504-324-6837
Mailing Address - Fax:504-861-1758
Practice Address - Street 1:220 TOPAZ ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-2634
Practice Address - Country:US
Practice Address - Phone:504-324-6837
Practice Address - Fax:504-861-1758
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical