Basic Information
Provider Information
NPI: 1104244110
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DARAY
FirstName: ELIZABETH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 525 RIDGEWAY DR
Address2:  
City: METAIRIE
State: LA
PostalCode: 700013048
CountryCode: US
TelephoneNumber: 5046443015
FaxNumber:  
Practice Location
Address1: 2626 CHARLES DR
Address2:  
City: CHALMETTE
State: LA
PostalCode: 700433779
CountryCode: US
TelephoneNumber: 5042784006
FaxNumber: 5042784007
Other Information
ProviderEnumerationDate: 04/07/2014
LastUpdateDate: 04/07/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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