Provider Demographics
NPI:1558889345
Name:BRIDGES, LAVONZELL RAINEY (LCSW-BACS)
Entity Type:Individual
Prefix:
First Name:LAVONZELL
Middle Name:RAINEY
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3358 ROGER WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2721
Mailing Address - Country:US
Mailing Address - Phone:504-289-4590
Mailing Address - Fax:
Practice Address - Street 1:2515 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6435
Practice Address - Country:US
Practice Address - Phone:504-822-0800
Practice Address - Fax:504-822-0831
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty