MEDICARE: ALICIA MONIQUE BRIDGES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	5175	LA
2	104100000X	Social Worker	5175	LA

General Provider Information

NPI Number	:	1225198278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA MONIQUE BRIDGES LCSW

Provider Business Mailing Address
First Line	:	125 RESHA RD
Second Line	:
City	:	BREAUX BRIDGE
State	:	LA
Zip	:	70517-8440
Country	:	US
Telephone Number	:	225-975-1571
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 W PINHOOK RD STE 102
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3735
Country	:	US
Telephone Number	:	337-282-7978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	04/16/2025

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