1932456142 NPI number — CHRISTOPHER BARACCO DPT

Table of content: ELLEN B GRAY PHD LCSW (NPI 1104938000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932456142 NPI number — CHRISTOPHER BARACCO DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARACCO
Provider First Name:
CHRISTOPHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932456142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 VETERANS MEMORIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70005-3026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-834-9259
Provider Business Mailing Address Fax Number:
504-834-9281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 OCHSNER BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-8147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-801-7145
Provider Business Practice Location Address Fax Number:
985-801-7146
Provider Enumeration Date:
08/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  08298 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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