MEDICARE: DR. BARAKA WHITTINGTON PEREZ PH.D., MP

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	1054	LA
2	103TP0016X	Prescribing (Medical) Psychologist	301800	LA

General Provider Information

NPI Number	:	1245426345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARAKA WHITTINGTON PEREZ PH.D., MP

Provider Business Mailing Address
First Line	:	3529 LAKE PALOURDE DR
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-5504
Country	:	US
Telephone Number	:	504-641-4438
Fax Number	:	504-641-6620

Provider Business Practice Location Address
First Line	:	2916 GENERAL DEGAULLE DR STE 104
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114
Country	:	US
Telephone Number	:	504-641-4438
Fax Number	:	504-641-6620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	09/11/2019

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Directions to “ DR. BARAKA WHITTINGTON PEREZ PH.D., MP” Practice Location

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