Provider Demographics
NPI:1396860698
Name:WANEK, CAROLYN DEGELOS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:DEGELOS
Last Name:WANEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 WAVERLY PL
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-2554
Mailing Address - Country:US
Mailing Address - Phone:504-669-7579
Mailing Address - Fax:504-454-6180
Practice Address - Street 1:701 METAIRIE RD STE 2A203
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4061
Practice Address - Country:US
Practice Address - Phone:504-669-7579
Practice Address - Fax:504-454-6180
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALCSW # 80671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical