Provider Demographics
NPI:1508588542
Name:INTERWOVEN PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:INTERWOVEN PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JADE
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:KOBAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-200-4297
Mailing Address - Street 1:1731 MILAN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:726 ADAMS ST APT A
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-3907
Practice Address - Country:US
Practice Address - Phone:504-515-1275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty