Provider Demographics
NPI:1053411678
Name:CENTANNI, ANGELA LOUISE (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOUISE
Last Name:CENTANNI
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 1:1706 CANNES DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2407
Mailing Address - Country:US
Mailing Address - Phone:985-652-4330
Mailing Address - Fax:985-652-4335
Practice Address - Street 1:1706 CANNES DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2407
Practice Address - Country:US
Practice Address - Phone:985-652-4330
Practice Address - Fax:985-652-4335
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALCSW 75531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical