Individual
MADELYN LIDRES OPERARIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
856 TEXAS AVE, SHREVEPORT, LA 71101-3400
(318) 221-2669
Mailing address
856 TEXAS AVE, SHREVEPORT, LA 71101-3400
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
17858
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M0000X
—
LA
Enumeration date
09/12/2023
Last updated
09/12/2023
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