Provider Demographics
NPI:1043629165
Name:DANA JUDICE LLC
Entity Type:Organization
Organization Name:DANA JUDICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-369-3000
Mailing Address - Street 1:411 WEEKS ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4551
Mailing Address - Country:US
Mailing Address - Phone:337-369-3000
Mailing Address - Fax:337-369-3001
Practice Address - Street 1:411 WEEKS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4551
Practice Address - Country:US
Practice Address - Phone:337-369-3000
Practice Address - Fax:337-369-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAJ7263OtherBLUECROSS
LA19649867Medicaid