Provider Demographics
NPI:1700919644
Name:TESSIER, EDITH S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:S
Last Name:TESSIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VAIL
Other - Middle Name:S
Other - Last Name:TESSIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:740 DANTE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-1014
Mailing Address - Country:US
Mailing Address - Phone:504-957-4295
Mailing Address - Fax:
Practice Address - Street 1:740 DANTE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-1014
Practice Address - Country:US
Practice Address - Phone:504-957-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA36231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700919644OtherBLUE CROSS BLUE SHIELD
1700919644OtherUNITED BEHAVIORAL HEALTH
1700919644OtherAETNA
1700919644OtherCIGNA
1700919644OtherMAGELLAN
LA5X562Medicare ID - Type Unspecified