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General NPI Number Information
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NPI Number | 1154394468
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Entity Type | Individual
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Provider Name | SARA JANE HYDE LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 1001 W PINHOOK RD
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City | LAFAYETTE
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State | LA
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Zip | 70503-2445
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Country | US
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Telephone | 337-237-9150
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1254
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City | BROUSSARD
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State | LA
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Zip | 70518-1254
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Country | US
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Telephone | 337-837-9837
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Fax | 337-837-3616
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1841
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License Number State | LA
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