Doctor Name: | AMY NICOLE DYSART |
NPI Number: | 1598050262 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 9020 |
Business Practice Address: | 908 Louisa Ave Rayne, LA - 705787230 |
Business Phone Number: | 2252700100 |
Business Fax Number: | |
Mailing Address: | 908 Louisa Ave, RAYNE |
State: | LA |
Postal Code: | 705787230 |
Phone Number: | 2252700100 |
Fax Number: | |
NPI Enumeration Date: | 06/10/2011 |
NPI Last Update Date: | 12/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 9020 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |