Provider Demographics
NPI:1003103029
Name:JUDICE, DANA (LCSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:JUDICE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6110
Mailing Address - Country:US
Mailing Address - Phone:337-993-7927
Mailing Address - Fax:337-856-8127
Practice Address - Street 1:217 W BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6110
Practice Address - Country:US
Practice Address - Phone:337-993-7927
Practice Address - Fax:337-856-8127
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA82451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical