Provider Demographics
NPI:1730489683
Name:AMIE, CYNTHIA W (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:W
Last Name:AMIE
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 1:1009 CARNATION ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-1900
Mailing Address - Country:US
Mailing Address - Phone:985-259-9786
Mailing Address - Fax:985-259-4020
Practice Address - Street 1:1009 CARNATION ST
Practice Address - Street 2:SUITE A
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-1900
Practice Address - Country:US
Practice Address - Phone:985-259-9786
Practice Address - Fax:985-259-4020
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA94831041C0700X
MSC76761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600705700Medicaid