Provider Demographics
NPI:1184719817
Name:SELENBERG, KAREN G (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:G
Last Name:SELENBERG
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 1:3801 NORTH CAUSEWAY BLVD.
Mailing Address - Street 2:SUITE 303
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-833-6303
Mailing Address - Fax:504-833-6322
Practice Address - Street 1:3801 NORTH CAUSEWAY BLVD.
Practice Address - Street 2:SUITE 303
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-833-6303
Practice Address - Fax:504-833-6322
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T35111041945Medicaid
LA5T35111041945Medicaid
LA5T3511Medicare UPIN