Provider Demographics
NPI:1215674908
Name:RYNOTT, STANLEY (LCSW)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:RYNOTT
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 1:4027 HIGHWAY 90 E
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-3509
Mailing Address - Country:US
Mailing Address - Phone:337-837-7174
Mailing Address - Fax:337-837-7176
Practice Address - Street 1:4027 HIGHWAY 90 E
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-3509
Practice Address - Country:US
Practice Address - Phone:337-837-7174
Practice Address - Fax:337-837-7176
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical