Provider Demographics
NPI:1457852782
Name:NEAL, ANTRONELLA GROSS
Entity Type:Individual
Prefix:
First Name:ANTRONELLA
Middle Name:GROSS
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47456 CASEY RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-3635
Mailing Address - Country:US
Mailing Address - Phone:985-474-1282
Mailing Address - Fax:
Practice Address - Street 1:4521 JAMESTOWN AVE STE 2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3234
Practice Address - Country:US
Practice Address - Phone:225-227-2548
Practice Address - Fax:888-425-0972
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician