1215412598 NPI number — DR. AMY LEONA SANDRIDGE LCSW, PHD

Table of content: DR. AMY LEONA SANDRIDGE LCSW, PHD (NPI 1215412598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215412598 NPI number — DR. AMY LEONA SANDRIDGE LCSW, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDRIDGE
Provider First Name:
AMY
Provider Middle Name:
LEONA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215412598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2626 CHARLES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHALMETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70043-3779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-278-4006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4228 HOUMA BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-454-7878
Provider Business Practice Location Address Fax Number:
504-883-3775
Provider Enumeration Date:
10/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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