Provider Demographics
NPI:1588623458
Name:JUDICE, ANDRE SAGRERA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:SAGRERA
Last Name:JUDICE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HOLIDAY BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5088
Mailing Address - Country:US
Mailing Address - Phone:985-624-2942
Mailing Address - Fax:
Practice Address - Street 1:201 HOLIDAY BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5088
Practice Address - Country:US
Practice Address - Phone:985-624-2942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2479101YM0800X
LA529106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist