Provider Demographics
NPI:1447680129
Name:DEROUEN, GERMAINE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:GERMAINE
Middle Name:
Last Name:DEROUEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2551
Mailing Address - Country:US
Mailing Address - Phone:337-269-1390
Mailing Address - Fax:337-291-2817
Practice Address - Street 1:311 NORMAN DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2551
Practice Address - Country:US
Practice Address - Phone:337-269-1390
Practice Address - Fax:337-291-2817
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical