Healthcare Provider Details

I. General information

NPI: 1841540325
Provider Name (Legal Business Name): BIANCHINI - FREY/SUNCOAST NEUROPSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 PERKINS RD SUITE 500
BATON ROUGE LA
70808-4237
US

IV. Provider business mailing address

2901 N I 10 SERVICE RD E SUITE 300
METAIRIE LA
70002-6137
US

V. Phone/Fax

Practice location:
  • Phone: 225-368-2297
  • Fax: 225-248-6932
Mailing address:
  • Phone: 504-780-1702
  • Fax: 504-780-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberMPAP.000028
License Number StateLA

VIII. Authorized Official

Name: DR. KEVIN J BIANCHINI
Title or Position: OWNER
Credential: PH.D.
Phone: 504-780-1702