Provider Demographics
NPI:1962025684
Name:FEZEKAS, ROBERT RICHARD II (LMSW, LAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RICHARD
Last Name:FEZEKAS
Suffix:II
Gender:M
Credentials:LMSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-2925
Mailing Address - Country:US
Mailing Address - Phone:504-239-4729
Mailing Address - Fax:
Practice Address - Street 1:201 GREENBRIER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7236
Practice Address - Country:US
Practice Address - Phone:504-239-4729
Practice Address - Fax:985-867-1154
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1518101YA0400X
LA144271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)