Provider Demographics
NPI:1245849322
Name:SPECIALIZED SOCIAL WORK SOLUTIONS
Entity type:Organization
Organization Name:SPECIALIZED SOCIAL WORK SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:FULLER
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,BACS
Authorized Official - Phone:225-931-2653
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:DUPLESSIS
Mailing Address - State:LA
Mailing Address - Zip Code:70728-0096
Mailing Address - Country:US
Mailing Address - Phone:225-931-2653
Mailing Address - Fax:225-677-8666
Practice Address - Street 1:39094 N ANGELLE CT OFC
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6192
Practice Address - Country:US
Practice Address - Phone:225-931-2653
Practice Address - Fax:225-677-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2486632Medicaid