Provider Demographics
NPI:1013256924
Name:LANZA JACOBSON, CYNTHIA (MSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:LANZA JACOBSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:LANZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 9219
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70055-9219
Mailing Address - Country:US
Mailing Address - Phone:504-835-5503
Mailing Address - Fax:
Practice Address - Street 1:3100 RIDGELAKE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4964
Practice Address - Country:US
Practice Address - Phone:504-835-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA282101YA0400X
LA33331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical