Provider Demographics
NPI:1366523383
Name:POOLEY, MICHAEL T (SOCIAL WORKER/LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:POOLEY
Suffix:
Gender:M
Credentials:SOCIAL WORKER/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 8TH STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380
Mailing Address - Country:US
Mailing Address - Phone:985-384-1935
Mailing Address - Fax:985-384-8196
Practice Address - Street 1:1109 8TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1900
Practice Address - Country:US
Practice Address - Phone:985-384-1935
Practice Address - Fax:985-384-8196
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H361Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER