Provider Demographics
NPI:1508343310
Name:SIRAGUSA, PAUL JOHN (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:SIRAGUSA
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 TULANE AVE # 3
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7185
Mailing Address - Country:US
Mailing Address - Phone:504-302-1323
Mailing Address - Fax:
Practice Address - Street 1:3303 TULANE AVE # 3
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7185
Practice Address - Country:US
Practice Address - Phone:504-302-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1187106H00000X
LA5341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist