Healthcare Provider Details

I. General information

NPI: 1447607692
Provider Name (Legal Business Name): LETRISE S GRANDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 CROWDER BLVD SUITE 208
NEW ORLEANS LA
70127-2429
US

IV. Provider business mailing address

2608 SAND BAR LN
MARRERO LA
70072-6073
US

V. Phone/Fax

Practice location:
  • Phone: 504-241-6006
  • Fax: 504-241-6007
Mailing address:
  • Phone: 504-427-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12472
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: