Provider Demographics
NPI:1700180502
Name:AMOS, CARLOS J (LCSW)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:J
Last Name:AMOS
Suffix:
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 1:4460 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3529
Mailing Address - Country:US
Mailing Address - Phone:504-364-6613
Mailing Address - Fax:504-364-6651
Practice Address - Street 1:690 E 1ST ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3546
Practice Address - Country:US
Practice Address - Phone:504-364-6613
Practice Address - Fax:504-364-6651
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA57121041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker