Provider Demographics
NPI:1962193664
Name:DRUMGOLD, MARY RETTA (MED, PLPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:RETTA
Last Name:DRUMGOLD
Suffix:
Gender:F
Credentials:MED, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9321 E CLAIBORNE PKWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70094-3751
Mailing Address - Country:US
Mailing Address - Phone:504-510-6808
Mailing Address - Fax:
Practice Address - Street 1:1042 ANNUNCIATION ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-3831
Practice Address - Country:US
Practice Address - Phone:504-910-9773
Practice Address - Fax:504-910-9773
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LAPLC9734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator