MEDICARE: AMANDA HIDALGO LCSW-BACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	8060	LA

General Provider Information

NPI Number	:	1194415059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA HIDALGO LCSW-BACS

Provider Business Mailing Address
First Line	:	1245 MELANIE ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-4745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 HIGHWAY 951
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748-5103
Country	:	US
Telephone Number	:	225-937-7426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	05/12/2023

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