Provider Demographics
NPI:1669901419
Name:GRUENIG, MADDISON E (MSW)
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:E
Last Name:GRUENIG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MADDISON
Other - Middle Name:
Other - Last Name:EBERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4300 S I 10 SERVICE RD W STE 102
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-7400
Mailing Address - Country:US
Mailing Address - Phone:504-267-7324
Mailing Address - Fax:504-267-5936
Practice Address - Street 1:255 W FLORIDA ST STE 200
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3022
Practice Address - Country:US
Practice Address - Phone:504-267-7324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA162621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical