Basic Information
| Provider Information | |||||||||
| NPI: | 1558889345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRIDGES | ||||||||
| FirstName: | LAVONZELL | ||||||||
| MiddleName: | RAINEY | ||||||||
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| Credential: | LCSW-BACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3358 ROGER WILLIAMS ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701192721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042894590 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2515 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048220800 | ||||||||
| FaxNumber: | 5048220831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2017 | ||||||||
| LastUpdateDate: | 08/31/2017 | ||||||||
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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 | 1041C0700X | 1645 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.