Provider Demographics
NPI:1043582349
Name:VINCENT, MIRIAM THELMA (LMSW)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:THELMA
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50140
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70150-0140
Mailing Address - Country:US
Mailing Address - Phone:504-558-9595
Mailing Address - Fax:
Practice Address - Street 1:701 LOYOLA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113
Practice Address - Country:US
Practice Address - Phone:504-558-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12160101YM0800X, 1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator