Healthcare Provider Details

I. General information

NPI: 1558324749
Provider Name (Legal Business Name): SUZANNE A CHABAUD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 METAIRIE RD STE 200
METAIRIE LA
70005-4337
US

IV. Provider business mailing address

3520 GENERAL DEGAULLE DR SUITE 4030
NEW ORLEANS LA
70114-6757
US

V. Phone/Fax

Practice location:
  • Phone: 504-915-9590
  • Fax: 504-309-4964
Mailing address:
  • Phone: 504-915-9590
  • Fax: 504-362-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number563
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: