Provider Demographics
NPI:1881742187
Name:CUNEO, CARLO J JR (LCSW)
Entity type:Individual
Prefix:
First Name:CARLO
Middle Name:J
Last Name:CUNEO
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 TEDDY DR
Mailing Address - Street 2:STE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1925
Mailing Address - Country:US
Mailing Address - Phone:225-923-8255
Mailing Address - Fax:877-761-3087
Practice Address - Street 1:3080 TEDDY DR
Practice Address - Street 2:STE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1925
Practice Address - Country:US
Practice Address - Phone:225-923-8255
Practice Address - Fax:225-923-8255
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1170054Medicaid
LA1170054Medicaid