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NPI Code Detail

MEDICARE: DR. SCUDDY F. FONTENELLE III PH.D.

MEDICARE: DR. SCUDDY F. FONTENELLE III PH.D.
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
1103TC2200XClinical Child & Adolescent Psychologist457LA
2103TS0200XSchool PsychologistSP301LA

General Provider Information

NPI Number : 1477577922
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCUDDY F. FONTENELLE III PH.D.
Provider Business Mailing Address
First Line : 118 RIDGELAKE DR
Second Line :
City : METAIRIE
State : LA
Zip : 70001-5312
Country : US
Telephone Number : 504-834-2775
Fax Number : 504-834-2378
Provider Business Practice Location Address
First Line : 118 RIDGELAKE DR
Second Line :
City : METAIRIE
State : LA
Zip : 70001-5312
Country : US
Telephone Number : 504-834-2775
Fax Number : 504-834-2378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 09/11/2025

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