=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689029274
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMONET PSYCHOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2016
-----------------------------------------------------
Last Update Date | 05/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 METAIRIE RD STE 201
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70005-4337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-408-1630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 METAIRIE RD STE 201
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70005-4337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-408-1630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. CARRIE W. EMONET
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 504-408-1630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 1162
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------