Healthcare Provider Details

I. General information

NPI: 1578611091
Provider Name (Legal Business Name): MS. DEBORAH KAY RIDGEWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 CHARLES DR
CHALMETTE LA
70043-3779
US

IV. Provider business mailing address

2350 PARK PLACE DR APT 199
GRETNA LA
70056-3077
US

V. Phone/Fax

Practice location:
  • Phone: 504-278-4006
  • Fax:
Mailing address:
  • Phone: 505-440-8674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-06358
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-12070
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925245
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: