Dominique Nicole Debetaz, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14411 Issued in LA

Practice address

10431 Siegen LN Ste 103
Baton Rouge, LA 70810-4984

Phone

(225) 777-6824

NPI assigned

Jun 12, 2017

Last updated

Feb 1, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dominique Debetaz Mitchell Former name

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dominique.debetaz.p1@direct.rkmprimarycare.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Primary Care Providers for a Healthy Feliciana, Inc.

  dba Clinton Lower Health Center

  • Federally Qualified Health Center (FQHC)
  • Clinton, LA
  • NPI 1821245127
  Medicare reassignment NPD
• Primary Care Providers for a Healthy Feliciana, Inc

  dba RKM at Springfield Elementary

  • Federally Qualified Health Center (FQHC)
  • Springfield, LA
  • NPI 1326923384
  NPD
• Primary Care Providers for a Healthy Feliciana, Inc.

  dba Jackson Complex Health Center

  • Federally Qualified Health Center (FQHC)
  • Jackson, LA
  • NPI 1437258043
  NPD
• Spectrum Rehab Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Denham Springs, LA
  • NPI 1356493530
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1043749138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24848 HERITAGE DR",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707266701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10431 SIEGEN LN STE 103",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708104984",
            "telephone_number": "225-777-6824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBETAZ",
        "first_name": "DOMINIQUE",
        "middle_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-12",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "14411",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255681128",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOMINIQUE",
            "last_name": "MITCHELL",
            "middle_name": "DEBETAZ",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristin Lynn Debate
• Debbie's Professional Medical Billing (Debbie's Professional Medical Billing, LLC)
• Lori Ann Debenedetto-Webb, MSW, LCSW
• Janeth Kay Debenedetto, LMT
• Nancy Jane Debessonet, M.A.
• Julianne Deblieux, PT
• Taylor Denise Debourg
• Mary Debrueys, M.C.D.
• Rebecca M Decker, LCSW
• Karen Declouet, M.S. CCC-SLP

• Clinical Social Worker in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Clinical Social Worker in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.