=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538993852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVY KATE FITZGERALD PLPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2024
-----------------------------------------------------
Last Update Date | 08/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3191 ALEX KORNMAN BLVD
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-762-8811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 822 S CLEARVIEW PKWY
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70123-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-736-1800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | PLC10188
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------