Geraldine Mack, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3681 Issued in LA

Practice address

1625 David Raines Rd
Shreveport, LA 71107-5899

Phone

(318) 425-2252

Fax

(318) 227-3357

NPI assigned

Jul 2, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346447315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 DAVID RAINES RD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711075899",
            "telephone_number": "318-425-2252",
            "fax_number": "318-227-3357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 DAVID RAINES RD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711075899",
            "telephone_number": "318-425-2252",
            "fax_number": "318-227-3357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "GERALDINE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "3681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED MARRIAGE AND FAM",
            "identifier": "MFT 852",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC CLINICAL SOCIAL WORKE",
            "identifier": "3681",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD LICENSE",
            "identifier": "3681",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mishuna Macdonald
• Netosha Macdonald, M. ED.
• April Macginley
• Denise Douglas Mack
• Donald Gene Mack Jr., MD
• Jayne Beauregard Mackey, LDN, RD
• Nimisha Madas, M.D.
• Claire Conerly Madden, CIT
• Michael Loring Madden, M.D.
• Karolyne Maddox, PA

• Clinical Social Worker in Shreveport, LA
• Providers in Shreveport, 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 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.