Provider Demographics
NPI:1871531582
Name:BONFANTI, LOUIS JASON II (LCSW)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:JASON
Last Name:BONFANTI
Suffix:II
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:109 YORKTOWN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3621
Mailing Address - Country:US
Mailing Address - Phone:318-487-9895
Mailing Address - Fax:318-767-3339
Practice Address - Street 1:109 YORKTOWN DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3621
Practice Address - Country:US
Practice Address - Phone:318-487-9895
Practice Address - Fax:318-767-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2008-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA18201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1655627Medicaid
LA1655627Medicaid