Provider Demographics
NPI:1528063302
Name:ST. ROMAIN, CHARLES MICHAEL (MSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:ST. ROMAIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:714 E KALISTE SALOOM RD
Mailing Address - Street 2:STE C3
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-2530
Mailing Address - Country:US
Mailing Address - Phone:337-233-5127
Mailing Address - Fax:337-837-4480
Practice Address - Street 1:714 E KALISTE SALOOM RD
Practice Address - Street 2:STE C3
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-2530
Practice Address - Country:US
Practice Address - Phone:337-233-5127
Practice Address - Fax:337-837-4480
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical