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General NPI Number Information
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NPI Number | 1184126369
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Entity Type | Individual
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Provider Name | EMILY PROVOSTY
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Gender | Female
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 04/29/2018
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Provider Practice Location Address
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Address Line | 4919 CANAL ST
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City | NEW ORLEANS
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State | LA
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Zip | 70119-5848
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Country | US
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Telephone | 504-483-9883
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 MYSTERY ST
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City | NEW ORLEANS
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State | LA
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Zip | 70119-3043
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Country | US
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Telephone | 504-756-7157
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 14707
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14707
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 14707
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License Number State | LA
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