Individual provider Active NPI

Maya R Bettagere, LCSW

  • Clinical Social Worker
  • Baton Rouge, LA
National Provider Identifier
1164575023
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
4630 Issued in LA
Practice address
4616 Government St
Building 2
Baton Rouge, LA 70806-5820
Phone
(225) 925-1906
Fax
(225) 925-1972
NPI assigned
Jan 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 4630 LA Primary

Addresses

Primary practice location

4616 Government St
Building 2
Baton Rouge, LA 70806-5820

Mailing address

4616 Government St
Building 2
Baton Rouge, LA 70806-5820
Phone (225) 925-1906

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4630LAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164575023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4616 GOVERNMENT ST",
            "address_2": "BUILDING 2",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708065820",
            "telephone_number": "225-925-1906",
            "fax_number": "225-925-1972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4616 GOVERNMENT ST",
            "address_2": "BUILDING 2",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708065820",
            "telephone_number": "225-925-1906",
            "fax_number": "225-925-1972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTAGERE",
        "first_name": "MAYA",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "4630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.