Provider Demographics
NPI:1962922138
Name:PICOU, SHARON DEWAN
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DEWAN
Last Name:PICOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3968 NORTH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3826
Mailing Address - Country:US
Mailing Address - Phone:225-478-9534
Mailing Address - Fax:225-478-9533
Practice Address - Street 1:299 BELLE TERRE BLVD STE E
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2425
Practice Address - Country:US
Practice Address - Phone:985-651-4612
Practice Address - Fax:985-651-4613
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator