Provider Demographics
NPI:1346573565
Name:RANSOM, SEAN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:RANSOM
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 1:4904 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1735
Mailing Address - Country:US
Mailing Address - Phone:504-383-3815
Mailing Address - Fax:855-502-8887
Practice Address - Street 1:4904 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-1735
Practice Address - Country:US
Practice Address - Phone:504-383-3815
Practice Address - Fax:855-502-8887
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMP.0024103TP0016X
HIPSY1096103TC0700X
LA1109103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1811904Medicaid
LA3B417DB49Medicare PIN