Healthcare Provider Details

I. General information

NPI: 1336565126
Provider Name (Legal Business Name): CORNELIA CAGER BONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 CHARLES DR
CHALMETTE LA
70043-3779
US

IV. Provider business mailing address

204 MAUMUS AVE
NEW ORLEANS LA
70131-7314
US

V. Phone/Fax

Practice location:
  • Phone: 504-278-4006
  • Fax: 504-278-4007
Mailing address:
  • Phone: 504-912-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2240
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: