Healthcare Provider Details

I. General information

NPI: 1609465004
Provider Name (Legal Business Name): STEPHANIE HOPE PROCELL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4932 TRENTON ST
METAIRIE LA
70006-6420
US

IV. Provider business mailing address

4932 TRENTON ST
METAIRIE LA
70006-6420
US

V. Phone/Fax

Practice location:
  • Phone: 813-363-0515
  • Fax:
Mailing address:
  • Phone: 813-363-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1622
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number024105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: