Healthcare Provider Details

I. General information

NPI: 1003467598
Provider Name (Legal Business Name): ANNE RARESHIDE BEACH LCSW-BACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 JENA ST
NEW ORLEANS LA
70115-6322
US

IV. Provider business mailing address

2529 JENA ST
NEW ORLEANS LA
70115-6322
US

V. Phone/Fax

Practice location:
  • Phone: 504-438-0767
  • Fax:
Mailing address:
  • Phone: 504-438-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number63033
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8014
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18162
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: