Basic Information
| Provider Information | |||||||||
| NPI: | 1639702046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEFFEN | ||||||||
| FirstName: | JESSIE | ||||||||
| MiddleName: | KERR | ||||||||
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| Credential: | CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 828 N GAYOSO ST APT D | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701194151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192598736 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1538 LOUISIANA AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701153553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048962345 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2020 | ||||||||
| LastUpdateDate: | 03/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 15693 | LA | N | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | 15693 | LA | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.