Individual provider Active NPI

Georgia Dahmes Queyrouze, LCSW

  • Clinical Social Worker
  • Mandeville, LA
National Provider Identifier
1235448374
Registry record updated Oct 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2946 Issued in LA
Practice address
4060 Azalea CT
Mandeville, LA 70448-7029
Phone
(985) 264-3598
Fax
(985) 674-0317
NPI assigned
Oct 6, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2946 LA Primary

Addresses

Primary practice location

4060 Azalea CT
Mandeville, LA 70448-7029

Mailing address

4060 Azalea CT
Mandeville, LA 70448-7029
Phone (985) 264-3598

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2964LAMDMental Health Counselor
2946LAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286323200000",
    "number": "1235448374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 AZALEA CT",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704487029",
            "telephone_number": "985-264-3598",
            "fax_number": "985-674-0317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 AZALEA CT",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704487029",
            "telephone_number": "985-264-3598",
            "fax_number": "985-674-0317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEYROUZE",
        "first_name": "GEORGIA",
        "middle_name": "DAHMES",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-06",
        "last_updated": "2010-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "2946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandeville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.