Provider Demographics
NPI:1043546476
Name:ANDERSON, LUCINDA THERESA
Entity type:Individual
Prefix:MRS
First Name:LUCINDA
Middle Name:THERESA
Last Name:ANDERSON
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 1:10555 LAKE FOREST BLVD STE 9E
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-5234
Mailing Address - Country:US
Mailing Address - Phone:504-220-1998
Mailing Address - Fax:504-241-7390
Practice Address - Street 1:7041 READ LANE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-5204
Practice Address - Country:US
Practice Address - Phone:504-220-1998
Practice Address - Fax:504-241-7390
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QA0600X261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care