Provider Demographics
NPI:1144591959
Name:CATALANELLO, MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:CATALANELLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SW RAILROAD AVE
Mailing Address - Street 2:SUITE 240 B
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5001
Mailing Address - Country:US
Mailing Address - Phone:985-634-9660
Mailing Address - Fax:
Practice Address - Street 1:1250 SW RAILROAD AVE
Practice Address - Street 2:SUITE 240 B
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5001
Practice Address - Country:US
Practice Address - Phone:985-634-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA657103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3D105OtherMEDICARE PTAN