Provider Demographics
NPI:1487147898
Name:SERIO, STEPHANIE M (BS, MA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:SERIO
Suffix:
Gender:F
Credentials:BS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9441 COMMON ST STE B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1463
Mailing Address - Country:US
Mailing Address - Phone:225-923-3733
Mailing Address - Fax:225-923-3735
Practice Address - Street 1:9441 COMMON ST STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1463
Practice Address - Country:US
Practice Address - Phone:225-923-3733
Practice Address - Fax:225-923-3735
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600964601Medicaid