Healthcare Provider Details

I. General information

NPI: 1235631177
Provider Name (Legal Business Name): ALLISON CARA KIDDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 N AVENUE L
CROWLEY LA
70526-3832
US

IV. Provider business mailing address

713 N AVENUE L
CROWLEY LA
70526-3832
US

V. Phone/Fax

Practice location:
  • Phone: 337-788-3330
  • Fax: 337-788-4770
Mailing address:
  • Phone: 337-788-3330
  • Fax: 337-788-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8618
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: