Provider Demographics
NPI:1710461637
Name:LEVY-JARVIS, LAN (MSW)
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:
Last Name:LEVY-JARVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:LA
Mailing Address - Zip Code:70086-7475
Mailing Address - Country:US
Mailing Address - Phone:504-654-8052
Mailing Address - Fax:
Practice Address - Street 1:4315 BLUEBONNET BLVD STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9661
Practice Address - Country:US
Practice Address - Phone:225-223-6968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11065104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker