Provider Demographics
NPI:1285131672
Name:CLABORN, VERONICA LEE (PLPC)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:LEE
Last Name:CLABORN
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 KEATING DR
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-1629
Mailing Address - Country:US
Mailing Address - Phone:504-393-5750
Mailing Address - Fax:504-393-5760
Practice Address - Street 1:115 KEATING DR
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-1629
Practice Address - Country:US
Practice Address - Phone:504-393-5750
Practice Address - Fax:504-393-5760
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA101Y00000XMedicaid