Provider Demographics
NPI:1245091008
Name:ROONEY, AMBER VICTORIA
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:VICTORIA
Last Name:ROONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SEABISCUIT LOOP N
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3510
Mailing Address - Country:US
Mailing Address - Phone:985-502-1213
Mailing Address - Fax:
Practice Address - Street 1:304 SEABISCUIT LOOP N
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3510
Practice Address - Country:US
Practice Address - Phone:985-502-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011536927171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator