Healthcare Provider Details

I. General information

NPI: 1336864461
Provider Name (Legal Business Name): JENA ZANCO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 RIVER HIGHLANDS BLVD
COVINGTON LA
70433-8987
US

IV. Provider business mailing address

671 RIVER HIGHLANDS BLVD
COVINGTON LA
70433-8987
US

V. Phone/Fax

Practice location:
  • Phone: 985-624-2942
  • Fax: 985-231-1373
Mailing address:
  • Phone: 985-624-2942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4966
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: