Basic Information
| Provider Information | |||||||||
| NPI: | 1043680879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDRES | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4480 GEN DEGAULLE DR | ||||||||
| Address2: | SUITE 117 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701316941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043096798 | ||||||||
| FaxNumber: | 5044072115 | ||||||||
| Practice Location | |||||||||
| Address1: | 4480 GEN DEGAULLE DR | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701316941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043096798 | ||||||||
| FaxNumber: | 5044072115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2015 | ||||||||
| LastUpdateDate: | 10/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 7493 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.