Individual
MARILYN MARIE FONSECA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
103 RUE BEAUREGARD, SUITE B, LAFAYETTE, LA 70508
(337) 278-4190
Mailing address
121 TANYA ST, LAFAYETTE, LA 70507-4825
(337) 278-4290
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2148
LA
1041C0700X
Clinical Social Worker
Primary
2148
LA
Other
Enumeration date
07/15/2013
Last updated
07/15/2013
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