Provider Demographics
NPI:1508206400
Name:DEDEAUX, ARTRONISE (LCSW)
Entity Type:Individual
Prefix:
First Name:ARTRONISE
Middle Name:
Last Name:DEDEAUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 PATRIOT ST
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4305
Mailing Address - Country:US
Mailing Address - Phone:504-371-1392
Mailing Address - Fax:
Practice Address - Street 1:822 S CLEARVIEW PKWY
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-3401
Practice Address - Country:US
Practice Address - Phone:504-371-1392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4243104100000X, 1041C0700X, 1041S0200X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1701033Medicaid