Provider Demographics
NPI:1124319348
Name:BONGIOVANI, GASPER JAMES (LCSW)
Entity type:Individual
Prefix:MR
First Name:GASPER
Middle Name:JAMES
Last Name:BONGIOVANI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 CANAL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6410
Mailing Address - Country:US
Mailing Address - Phone:504-432-4796
Mailing Address - Fax:
Practice Address - Street 1:2626 CANAL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6410
Practice Address - Country:US
Practice Address - Phone:504-525-2366
Practice Address - Fax:504-525-7525
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical