Provider Demographics
NPI:1396119558
Name:LIUZZA, GINA MARIE
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:LIUZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 S I 10 SERVICE RD W
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-7405
Mailing Address - Country:US
Mailing Address - Phone:504-301-9990
Mailing Address - Fax:
Practice Address - Street 1:4300 S I 10 SERVICE RD W STE 215
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7436
Practice Address - Country:US
Practice Address - Phone:504-301-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1396119558Medicaid