Basic Information
| Provider Information | |||||||||
| NPI: | 1134695398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRIDGES | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | SANDERS | ||||||||
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| Credential: | RSW, MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2313 EASTMERE ST | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700582214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043470961 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4700 WICHERS DR | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700723041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043191769 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2018 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 7589 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.