Provider Demographics
NPI:1760499081
Name:ROBICHEAUX, DUDLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:DUDLEY
Middle Name:
Last Name:ROBICHEAUX
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7107 ANNABELLE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8154
Mailing Address - Country:US
Mailing Address - Phone:225-924-0123
Mailing Address - Fax:225-924-5455
Practice Address - Street 1:4727 REVERE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3168
Practice Address - Country:US
Practice Address - Phone:225-924-0123
Practice Address - Fax:225-924-5455
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2220101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2220OtherLICENSED SOCIAL WORKER