Healthcare Provider Details

I. General information

NPI: 1194847970
Provider Name (Legal Business Name): JENNIFER COLLEENE MCCARROLL PH.D., M.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 S NORMAN C FRANCIS PKWY STE 314A
NEW ORLEANS LA
70125-1234
US

IV. Provider business mailing address

1050 S NORMAN C FRANCIS PKWY STE 314A
NEW ORLEANS LA
70125-1234
US

V. Phone/Fax

Practice location:
  • Phone: 504-500-1720
  • Fax: 866-606-9343
Mailing address:
  • Phone: 504-500-1720
  • Fax: 866-606-9343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number323932
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number015469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: