Provider Demographics
NPI:1205219581
Name:BARDERE, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BARDERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 RIDGEPOINT CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2890
Mailing Address - Country:US
Mailing Address - Phone:225-362-3220
Mailing Address - Fax:
Practice Address - Street 1:2156 WOODDALE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1476
Practice Address - Country:US
Practice Address - Phone:225-928-4040
Practice Address - Fax:225-928-4111
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator