Provider Demographics
NPI:1477918191
Name:LANDRY, KEAIRA J (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:KEAIRA
Middle Name:J
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11814 MARKET PLACE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6084
Mailing Address - Country:US
Mailing Address - Phone:225-955-8123
Mailing Address - Fax:
Practice Address - Street 1:11814 MARKET PLACE AVE STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6084
Practice Address - Country:US
Practice Address - Phone:225-955-8123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
LA13746171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical