Provider Demographics
NPI:1063463354
Name:JUDICE, TERRY T (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:T
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 1:141 RIDGEWAY DR.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503
Mailing Address - Country:US
Mailing Address - Phone:337-235-5088
Mailing Address - Fax:337-232-0022
Practice Address - Street 1:141 RIDGEWAY DR.
Practice Address - Street 2:SUITE 103
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-235-5088
Practice Address - Fax:337-232-0022
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X572Medicare ID - Type Unspecified