Provider Demographics
NPI:1023075314
Name:POOL, ELSA RAE (PHD LCSW)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:RAE
Last Name:POOL
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CODIFER BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005
Mailing Address - Country:US
Mailing Address - Phone:504-835-6320
Mailing Address - Fax:504-836-6980
Practice Address - Street 1:300 CODIFER BLVD
Practice Address - Street 2:STE A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005
Practice Address - Country:US
Practice Address - Phone:504-835-6320
Practice Address - Fax:504-836-6980
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X579Medicare ID - Type Unspecified