Healthcare Provider Details

I. General information

NPI: 1003446220
Provider Name (Legal Business Name): SAVANNA NELSON MALLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 VIRGIL ST
GRETNA LA
70053-2340
US

IV. Provider business mailing address

2403 CALHOUN ST
NEW ORLEANS LA
70118-6301
US

V. Phone/Fax

Practice location:
  • Phone: 504-304-6332
  • Fax:
Mailing address:
  • Phone: 228-297-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number15860
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: