Provider Demographics
NPI:1013472364
Name:PSYCHIATRY NOLA
Entity Type:Organization
Organization Name:PSYCHIATRY NOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:HAGEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-952-6322
Mailing Address - Street 1:1426 AMELIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3622
Mailing Address - Country:US
Mailing Address - Phone:504-952-6322
Mailing Address - Fax:504-897-4876
Practice Address - Street 1:1426 AMELIA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3622
Practice Address - Country:US
Practice Address - Phone:504-952-6322
Practice Address - Fax:504-897-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1609190636OtherCHILD AND ADOLESCENT PSYCHIATRY