Healthcare Provider Details

I. General information

NPI: 1316857568
Provider Name (Legal Business Name): JACOB MARCUS TADEVICH MSW, CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 MAGAZINE ST
NEW ORLEANS LA
70130-5016
US

IV. Provider business mailing address

1936 MAGAZINE ST
NEW ORLEANS LA
70130-5016
US

V. Phone/Fax

Practice location:
  • Phone: 504-529-5558
  • Fax: 504-529-8840
Mailing address:
  • Phone: 504-529-5558
  • Fax: 504-529-8840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number20053
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: