Provider Demographics
NPI:1780775510
Name:GOSSETT, JOAN WAELDE (LCSW-BACS)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:WAELDE
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-4244
Mailing Address - Country:US
Mailing Address - Phone:504-259-5626
Mailing Address - Fax:504-393-5633
Practice Address - Street 1:3708 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-3002
Practice Address - Country:US
Practice Address - Phone:504-393-5626
Practice Address - Fax:504-393-5633
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical