Provider Demographics
NPI:1568639052
Name:CASERTA, JANIS DUNNING (MED, NCC, CIT)
Entity type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:DUNNING
Last Name:CASERTA
Suffix:
Gender:F
Credentials:MED, NCC, CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3773
Mailing Address - Country:US
Mailing Address - Phone:985-892-1604
Mailing Address - Fax:985-892-1604
Practice Address - Street 1:1007 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3773
Practice Address - Country:US
Practice Address - Phone:985-892-1604
Practice Address - Fax:985-892-1604
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2380101YA0400X
LA207743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)