Healthcare Provider Details

I. General information

NPI: 1639667108
Provider Name (Legal Business Name): ELORIS SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 POYDRAS ST STE 900
NEW ORLEANS LA
70112-1282
US

IV. Provider business mailing address

1615 POYDRAS ST STE 900
NEW ORLEANS LA
70112-1282
US

V. Phone/Fax

Practice location:
  • Phone: 504-648-6730
  • Fax: 504-648-6701
Mailing address:
  • Phone: 504-648-6730
  • Fax: 504-648-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16251
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: