Healthcare Provider Details

I. General information

NPI: 1497031504
Provider Name (Legal Business Name): BRIDGETTE DENISE WEBSTER LCSW-BACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 GOODWOOD BLVD
BATON ROUGE LA
70815-6233
US

IV. Provider business mailing address

12000 GOODWOOD BLVD
BATON ROUGE LA
70815-6233
US

V. Phone/Fax

Practice location:
  • Phone: 225-964-5024
  • Fax:
Mailing address:
  • Phone: 225-964-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number3710
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3710
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: