Provider Demographics
NPI:1467856450
Name:LUNDGREN, KIMBERLY (LCSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:LUNDGREN
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 1:1436 ATHIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122
Mailing Address - Country:US
Mailing Address - Phone:504-432-0840
Mailing Address - Fax:
Practice Address - Street 1:4401 VETERANS MEMORIAL BLVD.
Practice Address - Street 2:STE. 201
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-875-2379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA80741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical