Healthcare Provider Details

I. General information

NPI: 1225603939
Provider Name (Legal Business Name): HAILEY MABILE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAILEY AMATO LCSW

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 CLAYCUT RD
BATON ROUGE LA
70806-7213
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-930-8155
  • Fax: 225-930-9954
Mailing address:
  • Phone: 225-930-8155
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number16555
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number16555
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: