Healthcare Provider Details

I. General information

NPI: 1275924102
Provider Name (Legal Business Name): AMANDA FALCON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 N 17TH ST
BATON ROUGE LA
70802
US

IV. Provider business mailing address

153 N 17TH ST
BATON ROUGE LA
70802-3800
US

V. Phone/Fax

Practice location:
  • Phone: 225-388-5855
  • Fax:
Mailing address:
  • Phone: 225-388-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12774
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12774
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: