Provider Demographics
NPI:1659138113
Name:BRADLEY, LAVONE DENICE
Entity Type:Individual
Prefix:
First Name:LAVONE
Middle Name:DENICE
Last Name:BRADLEY
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 1:1117 BELMERE LUXURY CT
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2969
Mailing Address - Country:US
Mailing Address - Phone:619-244-9740
Mailing Address - Fax:
Practice Address - Street 1:205 ENTERPRISE DR STE D
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2535
Practice Address - Country:US
Practice Address - Phone:619-244-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator