Provider Demographics
NPI:1407252604
Name:GERVEY, ROBERT L (PSYD MP CRC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:GERVEY
Suffix:
Gender:M
Credentials:PSYD MP CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 FOLSE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-1022
Mailing Address - Country:US
Mailing Address - Phone:504-265-8560
Mailing Address - Fax:504-224-2880
Practice Address - Street 1:3520 GENERAL DEGAULLE DR
Practice Address - Street 2:SUITE A
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6757
Practice Address - Country:US
Practice Address - Phone:504-362-8046
Practice Address - Fax:504-362-2215
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-15
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1247103TC0700X, 103TR0400X
LA300762103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation