MEDICARE: BARBARA MAIDEN LMSW

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	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor
3	104100000X	Social Worker	6502	LA

General Provider Information

NPI Number	:	1609242320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA MAIDEN LMSW

Provider Business Mailing Address
First Line	:	1513 LINE AVE
Second Line	:	STE 230
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4621
Country	:	US
Telephone Number	:	318-670-8858
Fax Number	:	318-670-8947

Provider Business Practice Location Address
First Line	:	7505 PINES RD STE 1200I
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-3900
Country	:	US
Telephone Number	:	318-670-8858
Fax Number	:	318-670-8947

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

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	12/21/2022

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Directions to “ BARBARA MAIDEN LMSW” Practice Location

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