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General NPI Number Information
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NPI Number | 1083270516
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Entity Type | Organization
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Legal Business Name | JNB PSYCHOLOGY GS LLC
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 6555 PERKINS RD STE 500
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City | BATON ROUGE
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State | LA
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Zip | 70808-4278
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Country | US
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Telephone | 504-780-1702
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 N I 10 SERVICE RD E STE 300
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City | METAIRIE
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State | LA
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Zip | 70002-6137
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Country | US
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Telephone | 504-301-7352
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KEVIN J BIANCHINI
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Credential | PHD
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Telephone | 504-780-1702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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