Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 8245 | LA |
NPI | 1003103029 |
---|---|
Provider Name | Dana Judice |
First Address | Lafayette, LA 70506-6110 |
Second Address | Lafayette, LA 70506-6110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 29/06/2011 |