Provider Demographics
NPI:1942737630
Name:PADILLA, GARY (LCSW,LAC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:LCSW,LAC
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW,LAC
Mailing Address - Street 1:850 LE BEAU ST
Mailing Address - Street 2:
Mailing Address - City:ARABI
Mailing Address - State:LA
Mailing Address - Zip Code:70032
Mailing Address - Country:US
Mailing Address - Phone:504-570-0414
Mailing Address - Fax:
Practice Address - Street 1:4150 EARHART BLVD
Practice Address - Street 2:4150 EARHART BLVD
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1955
Practice Address - Country:US
Practice Address - Phone:504-522-4475
Practice Address - Fax:504-821-7296
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA75691041C0700X
LA1569324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility