Provider Demographics
NPI:1801436811
Name:BAHAM, SHARONDA L (MSW, RSW)
Entity type:Individual
Prefix:
First Name:SHARONDA
Middle Name:L
Last Name:BAHAM
Suffix:
Gender:F
Credentials:MSW, RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N I 10 SERVICE RD W STE 129
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6831
Mailing Address - Country:US
Mailing Address - Phone:504-512-3037
Mailing Address - Fax:504-605-4657
Practice Address - Street 1:3925 N I 10 SERVICE RD W STE 129
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6831
Practice Address - Country:US
Practice Address - Phone:504-512-3037
Practice Address - Fax:504-605-4657
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8070104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker