Provider Demographics
NPI:1922700236
Name:CATANZARO, SHANNON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:CATANZARO
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 1:71129 SHADY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6924
Mailing Address - Country:US
Mailing Address - Phone:985-249-8235
Mailing Address - Fax:
Practice Address - Street 1:71129 SHADY LAKE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6924
Practice Address - Country:US
Practice Address - Phone:985-249-8235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4765101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health