Provider Demographics
NPI:1073236790
Name:AMEZCUA, JANELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:AMEZCUA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:ASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 LISBON DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1714
Mailing Address - Country:US
Mailing Address - Phone:757-329-2433
Mailing Address - Fax:
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-329-2433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040119821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical