Provider Demographics
NPI:1780895953
Name:HIDALGO, MYRA L (LCSW)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:L
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3505
Mailing Address - Country:US
Mailing Address - Phone:504-899-0244
Mailing Address - Fax:
Practice Address - Street 1:1407 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3505
Practice Address - Country:US
Practice Address - Phone:504-899-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical