Provider Demographics
NPI:1760774350
Name:COGNITIVEDEVELOPMENT CENTER OF BATON ROUGE
Entity Type:Organization
Organization Name:COGNITIVEDEVELOPMENT CENTER OF BATON ROUGE
Other - Org Name:COGNITIVE DEVELOPMENT CENTER OF LAFAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-614-7644
Mailing Address - Street 1:850 KALISTE SALOOM RD STE 121
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4230
Mailing Address - Country:US
Mailing Address - Phone:337-234-7109
Mailing Address - Fax:
Practice Address - Street 1:850 KALISTE SALOOM RD STE 121
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4230
Practice Address - Country:US
Practice Address - Phone:337-234-7109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health