Provider Demographics
NPI:1255578639
Name:KENTZEL, MARIA KOURTNEY (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:KOURTNEY
Last Name:KENTZEL
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 1:115 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3655
Mailing Address - Country:US
Mailing Address - Phone:985-400-1460
Mailing Address - Fax:
Practice Address - Street 1:211 N NEW HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3249
Practice Address - Country:US
Practice Address - Phone:985-400-1460
Practice Address - Fax:985-892-2807
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical