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General NPI Number Information
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NPI Number | 1801436811
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Entity Type | Individual
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Provider Name | SHARONDA L BAHAM MSW, RSW
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Gender | Female
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 3925 N I 10 SERVICE RD W STE 129
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City | METAIRIE
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State | LA
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Zip | 70002-6831
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Country | US
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Telephone | 504-512-3037
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Fax | 504-605-4657
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Provider Business Mailing Address
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Address Line | 3925 N I 10 SERVICE RD W STE 129
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City | METAIRIE
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State | LA
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Zip | 70002-6831
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Country | US
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Telephone | 504-512-3037
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Fax | 504-605-4657
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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 | 8070
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License Number State | LA
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