Individual
MS. DINA BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1510 NAPOLEON ST, MAMOU, LA 70554-2320
(337) 468-2333
(337) 468-3620
Mailing address
300 SOUTH ST, MAMOU, LA 70554-4422
(337) 468-5959
(337) 468-5966
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6039
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6039
LCSW LICENSE NUMBER
LA
Enumeration date
02/12/2007
Last updated
07/08/2007
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