Provider Demographics
NPI:1851842645
Name:DEMAGNUS, NADRA TYLISE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:NADRA
Middle Name:TYLISE
Last Name:DEMAGNUS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 ANNETTE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-1323
Mailing Address - Country:US
Mailing Address - Phone:504-600-8941
Mailing Address - Fax:
Practice Address - Street 1:1634 ANNETTE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70116-1323
Practice Address - Country:US
Practice Address - Phone:504-600-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12192104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker