Provider Demographics
NPI:1790348225
Name:BROOMS, CATERRA C (CSW)
Entity Type:Individual
Prefix:
First Name:CATERRA
Middle Name:C
Last Name:BROOMS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 FRAZIER RD
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1632
Mailing Address - Country:US
Mailing Address - Phone:318-202-3860
Mailing Address - Fax:318-202-5953
Practice Address - Street 1:1495 FRAZIER RD
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-1632
Practice Address - Country:US
Practice Address - Phone:318-202-3860
Practice Address - Fax:318-202-5953
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator