Provider Demographics
NPI:1942547245
Name:STANDIFER, ELIZABETH MOORE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MOORE
Last Name:STANDIFER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16851 JEFFERSON HWY STE 4C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-6990
Mailing Address - Country:US
Mailing Address - Phone:225-317-4365
Mailing Address - Fax:
Practice Address - Street 1:16851 JEFFERSON HWY STE 4C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-6990
Practice Address - Country:US
Practice Address - Phone:225-424-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63181041C0700X
OR75421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical