Healthcare Provider Details

I. General information

NPI: 1689077034
Provider Name (Legal Business Name): BIANCHINI-BRENNAN/STABLER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 LONESOME RD STE A
MANDEVILLE LA
70448-7085
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 985-246-2600
  • Fax: 985-246-2601
Mailing address:
  • Phone: 504-780-1702
  • Fax: 504-780-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1284
License Number StateLA

VIII. Authorized Official

Name: CHRISTINA BINDER STABLER
Title or Position: MEMBER
Credential: PHD
Phone: 504-780-1702