Basic Information
| Provider Information | |||||||||
| NPI: | 1568590289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIETZ | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ACSW GSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 DELOAKS DR | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704479788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9857921645 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 719 ELYSIAN FIELDS AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701178511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049428101 | ||||||||
| FaxNumber: | 5049428242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 5180 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.