Provider Demographics
NPI:1902194053
Name:SHANEYFELT, ELAINE E (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ELAINE
Middle Name:E
Last Name:SHANEYFELT
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 1:401 WHITNEY AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-2501
Mailing Address - Country:US
Mailing Address - Phone:504-366-6217
Mailing Address - Fax:504-366-7642
Practice Address - Street 1:401 WHITNEY AVE STE 205
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2501
Practice Address - Country:US
Practice Address - Phone:504-366-6217
Practice Address - Fax:504-366-7642
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA108821041C0700X
AL1640C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical