Provider Demographics
NPI:1568599819
Name:LANDRY, CECELIA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CECELIA
Middle Name:ANN
Last Name:LANDRY
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 1:8823 SAN JOSE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4290
Mailing Address - Country:US
Mailing Address - Phone:904-638-8164
Mailing Address - Fax:704-270-6207
Practice Address - Street 1:8823 SAN JOSE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4290
Practice Address - Country:US
Practice Address - Phone:904-638-8164
Practice Address - Fax:704-270-6207
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical