Healthcare Provider Details

I. General information

NPI: 1912372319
Provider Name (Legal Business Name): BRIDGET G SUIRE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 07/09/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 OLD HAMMOND HWY
BATON ROUGE LA
70816-8256
US

IV. Provider business mailing address

10065 OLD HAMMOND HWY
BATON ROUGE LA
70816-8256
US

V. Phone/Fax

Practice location:
  • Phone: 225-443-1508
  • Fax:
Mailing address:
  • Phone: 225-443-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3904
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: