Provider Demographics
NPI:1790814572
Name:SCOTT, MARY K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6554 FLORIDA BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4474
Mailing Address - Country:US
Mailing Address - Phone:225-928-1933
Mailing Address - Fax:225-928-5917
Practice Address - Street 1:6554 FLORIDA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4474
Practice Address - Country:US
Practice Address - Phone:225-928-1933
Practice Address - Fax:225-928-5917
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1787442Medicaid