Active NPI
Connie Pearl Broussard, LCSW, LMSW
- Professional Counselor
- Lafayette, LA
National Provider Identifier
1790953180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LCSW 9124
- Practice address
- 302 Dulles Dr
Suite 1
Lafayette, LA 70506-3008 - Phone
- (337) 262-5870
- Fax
- (337) 262-1272
- NPI assigned
- Feb 19, 2008
- Last updated
- Feb 13, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LCSW 9124 | LA | Primary |
| Clinical Social Worker | 1041C0700X | LMSW 9124 | LA |
Addresses
Primary practice location
302 Dulles Dr
Suite 1
Lafayette, LA 70506-3008
Mailing address
302 Dulles Dr
Suite 1
Lafayette, LA 70506-3008
Phone (337) 262-5870
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
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW 9124 | LA | MD | Professional Counselor |
| LMSW 9124 | LA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Louisiana Department of Health, Department of Health and Hospitals | Past | Accepting new patients | |
| Department of Health and Hospitals | Past | Accepting new patients |
Organizations & group practices 2
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329091200000",
"number": "1790953180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 DULLES DR",
"address_2": "SUITE 1",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705063008",
"telephone_number": "337-262-5870",
"fax_number": "337-262-1272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 DULLES DR",
"address_2": "SUITE 1",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705063008",
"telephone_number": "337-262-5870",
"fax_number": "337-262-1272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "CONNIE",
"middle_name": "PEARL",
"name_prefix": "Ms.",
"credential": "LCSW, LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-19",
"last_updated": "2012-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "LA",
"license": "LCSW 9124",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "LA",
"license": "LMSW 9124",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.