Healthcare Provider Details

I. General information

NPI: 1215412598
Provider Name (Legal Business Name): AMY LEONA SANDRIDGE LCSW, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 HOUMA BLVD STE 200
METAIRIE LA
70006-3004
US

IV. Provider business mailing address

2626 CHARLES DR
CHALMETTE LA
70043-3779
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-7878
  • Fax: 504-883-3775
Mailing address:
  • Phone: 504-278-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: