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General NPI Number Information
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NPI Number | 1467856450
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Entity Type | Individual
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Provider Name | KIMBERLY LUNDGREN L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 4401 VETERANS MEMORIAL BLVD. STE. 201
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City | METAIRIE
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State | LA
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Zip | 70006
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Country | US
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Telephone | 504-875-2379
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Fax |
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Provider Business Mailing Address
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Address Line | 1436 ATHIS ST
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City | NEW ORLEANS
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State | LA
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Zip | 70122
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Country | US
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Telephone | 504-432-0840
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8074
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License Number State | LA
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