Provider Demographics
NPI:1396827531
Name:VANGEFFEN, KIM E (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:E
Last Name:VANGEFFEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W. HARRISON AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2552
Mailing Address - Country:US
Mailing Address - Phone:504-286-1424
Mailing Address - Fax:504-286-1423
Practice Address - Street 1:141 W. HARRISON AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-7012
Practice Address - Country:US
Practice Address - Phone:504-286-1424
Practice Address - Fax:504-286-1423
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA453103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S024Medicare ID - Type Unspecified