Healthcare Provider Details

I. General information

NPI: 1982980926
Provider Name (Legal Business Name): SAJATA ELYSE VARNER LCSW-BACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LAFAYETTE ST RM 152
GRETNA LA
70053-5732
US

IV. Provider business mailing address

PO BOX 1531
GRETNA LA
70054-1531
US

V. Phone/Fax

Practice location:
  • Phone: 504-345-8331
  • Fax: 504-334-8817
Mailing address:
  • Phone: 504-345-8331
  • Fax: 504-334-8817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8712
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: