Healthcare Provider Details

I. General information

NPI: 1891351326
Provider Name (Legal Business Name): BIANCHINI-ESTEVE-EDWARDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7252 LAKESHORE DR
NEW ORLEANS LA
70124-2433
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: 504-323-3450
  • Fax:
Mailing address:
  • Phone: 504-780-1702
  • Fax: 504-780-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN J BIANCHINI
Title or Position: MANAGING MEMBER
Credential: PHD
Phone: 504-780-1702