Provider Demographics
NPI:1790550580
Name:SANDIFER, CHARRLYSE (LMSW)
Entity Type:Individual
Prefix:
First Name:CHARRLYSE
Middle Name:
Last Name:SANDIFER
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 1:5419 TULLIS DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8592
Mailing Address - Country:US
Mailing Address - Phone:504-391-7323
Mailing Address - Fax:
Practice Address - Street 1:4480 GENERAL DEGAULLE DR STE 206
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-6309
Practice Address - Country:US
Practice Address - Phone:504-905-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11489104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker