Provider Demographics
NPI:1881027175
Name:BIANCHINI SPENCER
Entity Type:Organization
Organization Name:BIANCHINI SPENCER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRESA
Authorized Official - Middle Name:ROEBUCK
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:504-780-1702
Mailing Address - Street 1:2901 N I 10 SERVICE RD E
Mailing Address - Street 2:STE 300
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6137
Mailing Address - Country:US
Mailing Address - Phone:504-780-1702
Mailing Address - Fax:504-780-1705
Practice Address - Street 1:2901 N I 10 SERVICE RD E
Practice Address - Street 2:STE 300
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6137
Practice Address - Country:US
Practice Address - Phone:504-780-1702
Practice Address - Fax:504-780-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1246103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty