Healthcare Provider Details

I. General information

NPI: 1114853868
Provider Name (Legal Business Name): LIPIKA CHAKRABARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 ELLERBE RD
SHREVEPORT LA
71106-7730
US

IV. Provider business mailing address

7410 MONTCLAIR DR
SHREVEPORT LA
71105-5020
US

V. Phone/Fax

Practice location:
  • Phone: 318-797-8500
  • Fax:
Mailing address:
  • Phone: 318-797-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-524696
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: