Healthcare Provider Details

I. General information

NPI: 1447379912
Provider Name (Legal Business Name): ELISSA S MILLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 RIVER ROAD
LULING LA
70070-4442
US

IV. Provider business mailing address

167 DIANNE DR
SAINT ROSE LA
70087-3742
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-5800
  • Fax: 985-785-5811
Mailing address:
  • Phone: 504-575-4662
  • Fax: 504-303-8554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4144
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: