Provider Demographics
NPI:1659716777
Name:ANDERSON, EMILY ADELE (CSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ADELE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 JEFFERSON PLACE BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-7687
Mailing Address - Country:US
Mailing Address - Phone:225-978-0779
Mailing Address - Fax:
Practice Address - Street 1:4939 JAMESTOWN AVE STE 101
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3229
Practice Address - Country:US
Practice Address - Phone:225-924-6621
Practice Address - Fax:225-924-6627
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical