Provider Demographics
NPI:1689689978
Name:LACOSTE, ALVIN W (LCSW)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:W
Last Name:LACOSTE
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 1:3300 WEST ESPLANADE AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-838-5716
Mailing Address - Fax:504-838-5714
Practice Address - Street 1:5001 WESTBANK EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-8708
Practice Address - Fax:504-329-8703
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3193104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1661341Medicaid
LA5T256Medicare ID - Type Unspecified
LA1661341Medicaid