Healthcare Provider Details

I. General information

NPI: 1821059155
Provider Name (Legal Business Name): BRENDA L. DURBIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7738 DON BUDGE AVE
BATON ROUGE LA
70810-1710
US

IV. Provider business mailing address

PO BOX 83980
BATON ROUGE LA
70884-3980
US

V. Phone/Fax

Practice location:
  • Phone: 225-292-0155
  • Fax: 844-718-7911
Mailing address:
  • Phone: 225-292-0155
  • Fax: 844-715-7911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4532
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: