Provider Demographics
NPI:1790818003
Name:MONTELEONE,MSW-LCSW, PATRICIA J (MSW-LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:J
Last Name:MONTELEONE,MSW-LCSW
Suffix:
Gender:F
Credentials:MSW-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WILKINSON ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-3533
Mailing Address - Country:US
Mailing Address - Phone:985-624-4450
Mailing Address - Fax:985-624-4461
Practice Address - Street 1:900 WILKINSON ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3533
Practice Address - Country:US
Practice Address - Phone:985-624-4450
Practice Address - Fax:985-624-4461
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
LA29651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721136960OtherTAX ID UNDER GROUP