Healthcare Provider Details

I. General information

NPI: 1053627968
Provider Name (Legal Business Name): JAY A. SEVIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 GENERAL MEYER AVE
NEW ORLEANS LA
70131-3529
US

IV. Provider business mailing address

4460 GENERAL MEYER AVE
NEW ORLEANS LA
70131-3529
US

V. Phone/Fax

Practice location:
  • Phone: 504-364-6613
  • Fax: 504-364-6652
Mailing address:
  • Phone: 504-364-6613
  • Fax: 504-364-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number735
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number735
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number735
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: