Provider Demographics
NPI:1164768263
Name:MENESES, AMY ANN (LCSW, C-SSWS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ANN
Last Name:MENESES
Suffix:
Gender:F
Credentials:LCSW, C-SSWS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ANN
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:152 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6054
Mailing Address - Country:US
Mailing Address - Phone:337-739-7796
Mailing Address - Fax:
Practice Address - Street 1:601 TEE MA RD.
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520
Practice Address - Country:US
Practice Address - Phone:337-521-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA82721041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool