Amy Nicole Dysart, LCSW
Individual provider Active NPI Clinical Social Worker · Rayne, LA
NPI 1598050262 · NPPES record last updated Dec 6, 2011
Key facts
- NPI
- 1598050262
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 9020 (LA)
- Practice address
- 908 Louisa Ave
Rayne, LA 70578-7230 - Phone
- (225) 270-0100
- NPI assigned
- Jun 10, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9020 | LA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mental Health Management, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 9020 | LA | Yes |
Addresses
Primary practice location
908 Louisa Ave
Rayne, LA 70578-7230
Mailing address
908 Louisa Ave
Rayne, LA 70578-7230
Phone (225) 270-0100
Other providers in Rayne, LA
- Mark Dawson
- DDMS of Louisiana No 2, LLC
- Danielle Kahanek Duhon
- Neal J Duhon
- Tunhi Duong
- Edwin Drive Group Home
- Edwin L Bercier IV DDS
- Andrew Joseph Eller
- Megan Estilette
- Olivia Fay Ewing
All providers in Rayne, LA · Clinical Social Worker in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.