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NPI Code Detail

MEDICARE: NORTHSHORE PSYCHIATRIC CARE

MEDICARE: NORTHSHORE PSYCHIATRIC CARE
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
12084N0400XNeurology Physician10858RLA

General Provider Information

NPI Number : 1700196912
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHSHORE PSYCHIATRIC CARE
Provider Business Mailing Address
First Line : 107 HIGHLAND PARK PLZ
Second Line : SUITE 107
City : COVINGTON
State : LA
Zip : 70433-7128
Country : US
Telephone Number : 985-875-7660
Fax Number : 985-875-7441
Provider Business Practice Location Address
First Line : 107 HIGHLAND PARK PLZ
Second Line : SUITE 107
City : COVINGTON
State : LA
Zip : 70433-7128
Country : US
Telephone Number : 985-875-7660
Fax Number : 985-875-7441
Authorized Official
Title or Position : OFFICE ADMINISTRATOR
Name : MRS. LAURIE V WILLIAMS
Credential :
Telephone Number : 985-875-7660
Provider Enumeration Date : 10/21/2010
Last Update Date : 08/28/2014

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Directions to “NORTHSHORE PSYCHIATRIC CARE ” Practice Location

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