Healthcare Provider Details

I. General information

NPI: 1104449388
Provider Name (Legal Business Name): DR. CHANDLER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 POYDRAS ST STE 900
NEW ORLEANS LA
70112-1282
US

IV. Provider business mailing address

5208 MAGAZINE ST STE 138
NEW ORLEANS LA
70115-1846
US

V. Phone/Fax

Practice location:
  • Phone: 504-708-4933
  • Fax: 833-708-4933
Mailing address:
  • Phone: 504-708-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN N CHANDLER
Title or Position: MEDICAL PSYCHOLOGIST
Credential: PSYD, MP
Phone: 504-708-4933