Provider Demographics
NPI:1265172852
Name:SMITH, CARLY JEANNETTE (LCSW)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:JEANNETTE
Last Name:SMITH
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 1:3134A CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4202
Mailing Address - Country:US
Mailing Address - Phone:504-507-0553
Mailing Address - Fax:504-309-1491
Practice Address - Street 1:3134A CALHOUN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-4202
Practice Address - Country:US
Practice Address - Phone:504-507-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA147381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical