Healthcare Provider Details

I. General information

NPI: 1629953658
Provider Name (Legal Business Name): SARAH ELIZABETH BRESEE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79131 LA-40
COVINGTON LA
70435
US

IV. Provider business mailing address

27372 DEBORAH DR
PONCHATOULA LA
70454-8122
US

V. Phone/Fax

Practice location:
  • Phone: 363-698-5892
  • Fax:
Mailing address:
  • Phone: 225-788-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number17707
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: