Provider Demographics
NPI:1366849390
Name:AMANDA R. DUPRE LCSW LLC
Entity type:Organization
Organization Name:AMANDA R. DUPRE LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-384-8876
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-0465
Mailing Address - Country:US
Mailing Address - Phone:337-384-8876
Mailing Address - Fax:337-783-5901
Practice Address - Street 1:1325 WRIGHT AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2226
Practice Address - Country:US
Practice Address - Phone:337-384-8876
Practice Address - Fax:337-384-8876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C758Medicare PIN