Healthcare Provider Details

I. General information

NPI: 1497319024
Provider Name (Legal Business Name): LEONARD GREGORY CRIDER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GREG CRIDER LCSW

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E ASCENSION COMPLEX BLVD
GONZALES LA
70737-4265
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-743-2445
  • Fax: 225-450-1150
Mailing address:
  • Phone: 225-743-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15347
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: