Healthcare Provider Details

I. General information

NPI: 1518027416
Provider Name (Legal Business Name): ANTHONY ANDREW MONTELEONE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 E WORTHY ST STE B
GONZALES LA
70737-4369
US

IV. Provider business mailing address

PO BOX 66558
BATON ROUGE LA
70896-6558
US

V. Phone/Fax

Practice location:
  • Phone: 225-621-5770
  • Fax: 225-644-3208
Mailing address:
  • Phone: 225-922-2700
  • Fax: 225-362-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4159
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: