Provider Demographics
NPI:1487664736
Name:WELLMAN, ANNA M (JD MSW LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:JD MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 JEFFERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115
Mailing Address - Country:US
Mailing Address - Phone:504-654-9093
Mailing Address - Fax:504-617-6343
Practice Address - Street 1:910 JEFFERSON AVENUE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115
Practice Address - Country:US
Practice Address - Phone:504-654-9093
Practice Address - Fax:504-617-6343
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3689104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1671096Medicaid
LA1671096Medicaid
LA5T848Medicare ID - Type Unspecified