Individual ProviderDina BroussardSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1510 Napoleon St, Mamou, LA 70554-2320(337) 468-2333(337) 468-5959PECOS EnrollmentBased on the most recent information from CMS, provider Dina Broussard is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1275675043Provider TypeIndividualFull NameBroussard, DinaTitleMs.CredentialLCSWGenderFemaleSole ProprietorYesEnumeration Date2/12/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address1510 Napoleon St, Mamou, LA 70554-2320Phone(337) 468-2333Fax(337) 468-3620Mailing LocationMailing Address300 South St, Mamou, LA 70554-4422Phone(337) 468-5959Fax(337) 468-5966Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense6039LouisianaProvider IdentifiersIDDescriptionIssuerID6039DescriptionOtherIssuerLCSW LICENSE NUMBERLouisiana