Provider Demographics
NPI:1619577426
Name:SPADY-GROVE, KYMBERLY MARSHAWN
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:MARSHAWN
Last Name:SPADY-GROVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 SATURN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2270
Mailing Address - Country:US
Mailing Address - Phone:504-253-4671
Mailing Address - Fax:
Practice Address - Street 1:1790 SATURN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2270
Practice Address - Country:US
Practice Address - Phone:504-253-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000052711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical