Provider Demographics
NPI:1619900016
Name:JALENAK, MIMI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIMI
Middle Name:
Last Name:JALENAK
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 1:6221 S CLAIBORNE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4148
Mailing Address - Country:US
Mailing Address - Phone:504-861-0859
Mailing Address - Fax:504-861-2112
Practice Address - Street 1:6221 S CLAIBORNE AVE STE 200
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-4148
Practice Address - Country:US
Practice Address - Phone:504-861-0859
Practice Address - Fax:504-861-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA24391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT260Medicare UPIN