Provider Demographics
NPI:1760659551
Name:SMITH, JUAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:SMITH
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 1:8414 BLUEBONNET BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2840
Mailing Address - Country:US
Mailing Address - Phone:225-978-7897
Mailing Address - Fax:
Practice Address - Street 1:8414 BLUEBONNET BLVD STE 110
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2840
Practice Address - Country:US
Practice Address - Phone:225-978-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA77181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7718OtherLCSW