MEDICARE: OCD INSTITUTE OF GREATER NEW ORLEANS, 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	103TC0700X	Clinical Psychologist	563	LA

General Provider Information

NPI Number	:	1043733009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCD INSTITUTE OF GREATER NEW ORLEANS, LLC

Provider Business Mailing Address
First Line	:	12333 WILLOW DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70131-3174
Country	:	US
Telephone Number	:	504-915-9590
Fax Number	:	504-309-4964

Provider Business Practice Location Address
First Line	:	315 METAIRIE RD STE 200
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70005-4337
Country	:	US
Telephone Number	:	504-915-9590
Fax Number	:	504-309-4964

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	SUZANNE A CHABAUD
Credential	:	PHD
Telephone Number	:	504-915-9590

Provider Enumeration Date	:	07/21/2017
Last Update Date	:	07/21/2017

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