Provider Demographics
NPI:1215085485
Name:MCGILLIVRAY, KAREN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:
Last Name:MCGILLIVRAY
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 1:3143 DAUPHINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-6726
Mailing Address - Country:US
Mailing Address - Phone:504-944-8948
Mailing Address - Fax:877-576-7316
Practice Address - Street 1:103 E X ST
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-1201
Practice Address - Country:US
Practice Address - Phone:504-394-5309
Practice Address - Fax:877-902-5562
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA30741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X158Medicare ID - Type Unspecified