Provider Demographics
NPI:1326157157
Name:PARDO, HAZEL G (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:G
Last Name:PARDO
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:BONNYE
Other - Middle Name:G
Other - Last Name:PARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:1924 D CORPORATE SQUARE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-646-0303
Mailing Address - Fax:985-646-0358
Practice Address - Street 1:1924 D CORPORATE SQUARE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-646-0303
Practice Address - Fax:985-646-0358
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1834104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S517Medicare ID - Type Unspecified