Provider Demographics
NPI:1962874420
Name:HARGROVE, LENITA (RSW)
Entity type:Individual
Prefix:MISS
First Name:LENITA
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:MISS
Other - First Name:LENITA
Other - Middle Name:
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RSW
Mailing Address - Street 1:111 PINERIDGE ST W
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7542
Mailing Address - Country:US
Mailing Address - Phone:281-813-5274
Mailing Address - Fax:225-291-9692
Practice Address - Street 1:1417 W MORRIS AVE
Practice Address - Street 2:SUITE E
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-542-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11110104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600751961Medicaid