Provider Demographics
NPI:1073831046
Name:HARDY, LORETTA M (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:M
Last Name:HARDY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9034 S BLUEBIRD LN
Mailing Address - Street 2:
Mailing Address - City:CADDO
Mailing Address - State:OK
Mailing Address - Zip Code:74729-5295
Mailing Address - Country:US
Mailing Address - Phone:580-889-0208
Mailing Address - Fax:
Practice Address - Street 1:9034 S BLUEBIRD LN
Practice Address - Street 2:
Practice Address - City:CADDO
Practice Address - State:OK
Practice Address - Zip Code:74729-5295
Practice Address - Country:US
Practice Address - Phone:580-889-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical