Provider Demographics
NPI:1194951681
Name:PAMELA T. MONG CLINICAL SOCIAL WORK ASSOCIATES LLC
Entity type:Organization
Organization Name:PAMELA T. MONG CLINICAL SOCIAL WORK ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MONG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-293-2255
Mailing Address - Street 1:9456 JEFFERSON HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2883
Mailing Address - Country:US
Mailing Address - Phone:225-293-2255
Mailing Address - Fax:225-292-1900
Practice Address - Street 1:9456 JEFFERSON HWY
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2883
Practice Address - Country:US
Practice Address - Phone:225-293-2255
Practice Address - Fax:225-292-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1619991825OtherNPI
LA5S307Medicare PIN