Provider Demographics
NPI:1326325127
Name:GERIATRIC PSYCHOLOGICAL SERVICES OF LOUISIANA APC
Entity Type:Organization
Organization Name:GERIATRIC PSYCHOLOGICAL SERVICES OF LOUISIANA APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:X
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MP
Authorized Official - Phone:337-267-1444
Mailing Address - Street 1:100 ASMA BLVD
Mailing Address - Street 2:SUITE 237E
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3858
Mailing Address - Country:US
Mailing Address - Phone:337-267-1444
Mailing Address - Fax:
Practice Address - Street 1:100 ASMA BLVD
Practice Address - Street 2:SUITE 237E
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3858
Practice Address - Country:US
Practice Address - Phone:337-267-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty