Active NPI
Stacey F. Kidder, M.S.W, L.C.S.W.
- Clinical Social Worker
- Baton Rouge, LA
National Provider Identifier
1679607295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6765
- Practice address
- 9035 Bluebonnet Blvd.
BLDG. 1
Baton Rouge, LA 70810 - Phone
- (225) 769-5990
- NPI assigned
- Mar 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6765 | LA | Primary |
Addresses
Primary practice location
9035 Bluebonnet Blvd.
BLDG. 1
Baton Rouge, LA 70810
Mailing address
9035 Bluebonnet Blvd
BLDG. 1
Baton Rouge, LA 70810-2841
Phone (225) 769-5990
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060306000042 | LA | Practitioner - Clinical Social Worker | 1658387329 | Practice locations: Baton Rouge, LA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
150 B Staring LN
Baton Rouge, LA 70810-4061
Phone (225) 769-5990
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6765 | LA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370822400000",
"number": "1679607295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9035 BLUEBONNET BLVD",
"address_2": "BLDG. 1",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708102841",
"telephone_number": "225-769-5990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9035 BLUEBONNET BLVD.",
"address_2": "BLDG. 1",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "70810",
"telephone_number": "225-769-5990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDDER",
"first_name": "STACEY",
"middle_name": "F.",
"name_prefix": "Mrs.",
"credential": "M.S.W, L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-15",
"last_updated": "2013-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "LA",
"license": "6765",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.