Provider Demographics
NPI:1720512825
Name:KAREN G SELENBERG LCSW LLC
Entity type:Organization
Organization Name:KAREN G SELENBERG LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SELENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:504-388-5110
Mailing Address - Street 1:146 AVANT GARDE CIR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-6273
Mailing Address - Country:US
Mailing Address - Phone:504-388-5110
Mailing Address - Fax:504-837-9857
Practice Address - Street 1:2420 ATHANIA PKWY
Practice Address - Street 2:STE 102
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1975
Practice Address - Country:US
Practice Address - Phone:504-833-6303
Practice Address - Fax:504-837-9857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T351Medicare UPIN