Healthcare Provider Details

I. General information

NPI: 1528590072
Provider Name (Legal Business Name): CASSANDRA JO LENTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 TULANE AVENUE #8448
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

3321 GENERAL TAYLOR ST
NEW ORLEANS LA
70125-4505
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-4272
  • Fax: 504-988-1665
Mailing address:
  • Phone: 815-878-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number320070
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: