Provider Demographics
NPI:1720358757
Name:STATEN, SHANELLE R
Entity Type:Individual
Prefix:
First Name:SHANELLE
Middle Name:R
Last Name:STATEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANELLE
Other - Middle Name:R
Other - Last Name:STATEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:2626 CANAL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6400
Mailing Address - Country:US
Mailing Address - Phone:504-525-2366
Mailing Address - Fax:
Practice Address - Street 1:2626 CANAL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6400
Practice Address - Country:US
Practice Address - Phone:504-525-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst