Provider Demographics
NPI:1477577922
Name:FONTENELLE, SCUDDY F III (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCUDDY
Middle Name:F
Last Name:FONTENELLE
Suffix:III
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 1:118 RIDGELAKE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5312
Mailing Address - Country:US
Mailing Address - Phone:504-834-2775
Mailing Address - Fax:504-834-2378
Practice Address - Street 1:118 RIDGELAKE DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5312
Practice Address - Country:US
Practice Address - Phone:504-834-2775
Practice Address - Fax:504-834-2378
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA457103TC2200X
LASP301103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool