Provider Demographics
NPI:1366742835
Name:GROOVER, BENJAMIN R (LCSW)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:R
Last Name:GROOVER
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 1:620 N MORRISON BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2312
Mailing Address - Country:US
Mailing Address - Phone:985-543-4109
Mailing Address - Fax:985-543-4109
Practice Address - Street 1:620 N MORRISON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2312
Practice Address - Country:US
Practice Address - Phone:985-543-4113
Practice Address - Fax:985-543-4109
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4997104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical