Provider Demographics
NPI:1467805564
Name:CHISESI, KIMBERLY W (LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:W
Last Name:CHISESI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 PORT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-7015
Mailing Address - Country:US
Mailing Address - Phone:504-930-1225
Mailing Address - Fax:985-231-1377
Practice Address - Street 1:1911 PORT ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-7015
Practice Address - Country:US
Practice Address - Phone:504-930-1225
Practice Address - Fax:985-231-1377
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA152371041C0700X, 104100000X
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3379201Medicaid