Provider Demographics
NPI:1336376102
Name:SHARKEY, LESA K (LCSW)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:K
Last Name:SHARKEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LESA
Other - Middle Name:K
Other - Last Name:SCHRIMSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:718 WEST NEW RIVER ST.
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-2502
Mailing Address - Country:US
Mailing Address - Phone:225-936-9142
Mailing Address - Fax:225-644-9962
Practice Address - Street 1:718 WEST NEW RIVER ST.
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2502
Practice Address - Country:US
Practice Address - Phone:225-936-9142
Practice Address - Fax:225-644-9962
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58981041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LANI6382LSOtherBLUE CROSS PROVIDER
LA3B277OtherMEDICARE PTAN
LAPTAN3B277Medicare PIN