Healthcare Provider Details

I. General information

NPI: 1508386327
Provider Name (Legal Business Name): CECELIA ROUSSEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LOYOLA AVE
NEW ORLEANS LA
70113-1912
US

IV. Provider business mailing address

701 LOYOLA AVE
NEW ORLEANS LA
70113-1912
US

V. Phone/Fax

Practice location:
  • Phone: 504-332-5718
  • Fax: 504-587-1537
Mailing address:
  • Phone: 504-332-5718
  • Fax: 504-587-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: