Provider Demographics
NPI:1184072647
Name:CHARTWELL CONSORTIUM
Entity type:Organization
Organization Name:CHARTWELL CONSORTIUM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LASSERRE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D, LBA
Authorized Official - Phone:504-899-2478
Mailing Address - Street 1:1225 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-4219
Mailing Address - Country:US
Mailing Address - Phone:504-899-2478
Mailing Address - Fax:504-899-2416
Practice Address - Street 1:1225 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-4219
Practice Address - Country:US
Practice Address - Phone:504-899-2478
Practice Address - Fax:504-899-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-220251S00000X, 261QM1300X
261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty