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5630 Read Blvd New Orleans LA 70127-3106 | |
| (504) 361-6500 | |
| (504) 243-7610 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5630 Read Blvd, New Orleans, Louisiana |
| Authorized Official Name and Position | Traci R Brown (CHIEF FISCAL OFFICER) |
| Authorized Official Contact | 5045683130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
400 Poydras Street Ste 1800 New Orleans LA 70130 Ph: (504) 568-3130 | 5630 Read Blvd New Orleans LA 70127-3106 Ph: (504) 361-6500 |
| NPI Number | 1790990604 |
|---|---|
| Provider Enumeration Date | 05/14/2007 |
| Last Update Date | 06/03/2021 |
| Certification Date | 06/03/2021 |
| Medicare PECOS PAC ID | 6901966407 |
|---|---|
| Medicare Enrollment ID | O20081202000495 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790990604 | NPI | - | NPPES |
| 1710610 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 140 (Louisiana) | Primary |
| Provider Name | Jennifer R Velander |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023272192 PECOS PAC ID: 4183932064 Enrollment ID: I20170328001008 |
| Provider Name | Marchant Woodhouse Van Gerpen |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1396791794 PECOS PAC ID: 5193783850 Enrollment ID: I20240924004455 |
| Provider Name | Rochelle Latrice Head-dunham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942570494 PECOS PAC ID: 2163963448 Enrollment ID: I20241029000219 |
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