Provider Demographics
NPI:1649814674
Name:BACKE, ELIZABETH SCHNEIDER
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SCHNEIDER
Last Name:BACKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETSEY
Other - Middle Name:
Other - Last Name:BACKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3443 ESPLANADE AVE APT 555
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2967
Mailing Address - Country:US
Mailing Address - Phone:504-313-2913
Mailing Address - Fax:
Practice Address - Street 1:433 METAIRIE RD STE 315
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4326
Practice Address - Country:US
Practice Address - Phone:504-313-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty