Provider Demographics
NPI:1720734205
Name:MACIAS-ARREDONDO, ANAYT DE JESUS
Entity Type:Individual
Prefix:
First Name:ANAYT
Middle Name:DE JESUS
Last Name:MACIAS-ARREDONDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 S PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-3422
Mailing Address - Country:US
Mailing Address - Phone:225-210-0360
Mailing Address - Fax:
Practice Address - Street 1:1028 E WORTHY ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4367
Practice Address - Country:US
Practice Address - Phone:504-399-9851
Practice Address - Fax:225-612-6632
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst