MEDICARE: BIANCHINI-MACCIOCCHI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1023540747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIANCHINI-MACCIOCCHI LLC

Provider Business Mailing Address
First Line	:	2901 N I 10 SERVICE RD E
Second Line	:	STE 300
City	:	METAIRIE
State	:	LA
Zip	:	70002-6137
Country	:	US
Telephone Number	:	504-780-1702
Fax Number	:

Provider Business Practice Location Address
First Line	:	5775 PEACHTREE DUNWOODY RD NE
Second Line	:	BUILDING C SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30342-1501
Country	:	US
Telephone Number	:	404-623-5206
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. STEPHEN MACCIOCCHI
Credential	:	PHD
Telephone Number	:	504-780-1702

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	03/31/2017

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