Healthcare Provider Details

I. General information

NPI: 1831659432
Provider Name (Legal Business Name): BIANCA LINDSEY WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BIANCA LINDSEY SIGEL

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 CANAL ST # 8448
NEW ORLEANS LA
70112-2703
US

IV. Provider business mailing address

1440 CANAL ST STE 8448
NEW ORLEANS LA
70112-2703
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-4272
  • Fax: 504-988-1665
Mailing address:
  • Phone: 512-826-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number328214
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: