Provider Demographics
NPI:1104235647
Name:PRUDHOMME, SHARON (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:PRUDHOMME
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W PRIEN LAKE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8349
Mailing Address - Country:US
Mailing Address - Phone:318-229-6662
Mailing Address - Fax:
Practice Address - Street 1:710 W PRIEN LAKE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8349
Practice Address - Country:US
Practice Address - Phone:318-229-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA124671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical