Provider Demographics
NPI:1184081143
Name:PELLISSIER, COLETTE (CSW)
Entity type:Individual
Prefix:MISS
First Name:COLETTE
Middle Name:
Last Name:PELLISSIER
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 1:409 CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3641
Mailing Address - Country:US
Mailing Address - Phone:985-249-4172
Mailing Address - Fax:
Practice Address - Street 1:3801 CANAL ST STE 220
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6084
Practice Address - Country:US
Practice Address - Phone:504-482-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker