Provider Demographics
NPI:1942238548
Name:ELLENDER, CAROLYN P (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:P
Last Name:ELLENDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 THIBODEAUX AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8239
Mailing Address - Country:US
Mailing Address - Phone:225-926-4009
Mailing Address - Fax:225-926-4069
Practice Address - Street 1:1651 THIBODEAUX AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8239
Practice Address - Country:US
Practice Address - Phone:225-926-4009
Practice Address - Fax:225-926-4069
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical