Provider Demographics
NPI:1174718811
Name:NOSACKA, JOHN D (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:NOSACKA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3843 HARDING BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807-5224
Mailing Address - Country:US
Mailing Address - Phone:225-359-9315
Mailing Address - Fax:225-359-9326
Practice Address - Street 1:3843 HARDING BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5224
Practice Address - Country:US
Practice Address - Phone:225-359-9315
Practice Address - Fax:225-359-9326
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical