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General NPI Number Information
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NPI Number | 1841540325
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Entity Type | Organization
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Legal Business Name | BIANCHINI - FREY/SUNCOAST NEUROPSYCHOLOGY, LLC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 6555 PERKINS RD SUITE 500
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City | BATON ROUGE
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State | LA
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Zip | 70808-4237
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Country | US
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Telephone | 225-368-2297
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Fax | 225-248-6932
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Provider Business Mailing Address
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Address Line | 2901 N I 10 SERVICE RD E SUITE 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 | 504-780-1702
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Fax | 504-780-1705
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN J BIANCHINI
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Credential | PH.D.
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | MPAP.000028
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License Number State | LA
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