Healthcare Provider Details

I. General information

NPI: 1023722279
Provider Name (Legal Business Name): MASTER CLINICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 WESTBEND PKWY STE 4098
NEW ORLEANS LA
70114-2470
US

IV. Provider business mailing address

121 METAIRIE LAWN DR STE A
METAIRIE LA
70001-5448
US

V. Phone/Fax

Practice location:
  • Phone: 908-217-5070
  • Fax: 504-362-2215
Mailing address:
  • Phone: 908-217-5070
  • Fax: 504-362-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT GERVEY
Title or Position: OWNER
Credential: PSY.D, MP
Phone: 908-217-5070