Provider Demographics
NPI:1184874380
Name:CHAPLAIN, MAURINE O (LCSW)
Entity type:Individual
Prefix:
First Name:MAURINE
Middle Name:O
Last Name:CHAPLAIN
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 1:39394 RAIFORD RD
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-8020
Mailing Address - Country:US
Mailing Address - Phone:985-320-0209
Mailing Address - Fax:
Practice Address - Street 1:54002 HIGHWAY 1062
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-3538
Practice Address - Country:US
Practice Address - Phone:985-606-9000
Practice Address - Fax:985-878-1900
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5489104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5489OtherLCSW LICENSE