Provider Demographics
NPI:1598829533
Name:MADER, JUDITH M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:M
Last Name:MADER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:M
Other - Last Name:WEICHENTHAL-MADER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:206 E MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-4247
Mailing Address - Country:US
Mailing Address - Phone:985-429-8040
Mailing Address - Fax:985-542-6990
Practice Address - Street 1:206 E MORRIS AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-4247
Practice Address - Country:US
Practice Address - Phone:985-429-8040
Practice Address - Fax:985-542-6990
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA71161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNIP792OtherSTATE LICENSE - RETIRED
LA7116OtherSTATE LICENSE
TNIP792OtherSTATE LICENSE - RETIRED