Provider Demographics
NPI:1083749071
Name:AUBREY, AGNES (MSWGSW)
Entity Type:Individual
Prefix:MS
First Name:AGNES
Middle Name:
Last Name:AUBREY
Suffix:
Gender:F
Credentials:MSWGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 WISTERIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4866
Mailing Address - Country:US
Mailing Address - Phone:504-201-3631
Mailing Address - Fax:
Practice Address - Street 1:4422 GENERAL MEYER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3588
Practice Address - Country:US
Practice Address - Phone:504-361-6491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA57161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical