Provider Demographics
NPI:1194067165
Name:ANTONELLIS, CHRISTEL (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:
Last Name:ANTONELLIS
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 1:3500 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6109
Mailing Address - Country:US
Mailing Address - Phone:504-571-8273
Mailing Address - Fax:504-571-8284
Practice Address - Street 1:3500 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6109
Practice Address - Country:US
Practice Address - Phone:504-571-8273
Practice Address - Fax:504-571-8284
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA104491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical