Basic Information
| Provider Information | |||||||||
| NPI: | 1225009129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PICKENS-SENTINO | ||||||||
| FirstName: | PATRICE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-BACS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PICKENS-SENTINO | ||||||||
| OtherFirstName: | PATRICE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSW, LCSW-BACS | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5630 CROWDER BLVD. | ||||||||
| Address2: | STE. 208 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044394823 | ||||||||
| FaxNumber: | 5042416007 | ||||||||
| Practice Location | |||||||||
| Address1: | 5630 CROWDER BLVD. | ||||||||
| Address2: | STE. 208 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044394823 | ||||||||
| FaxNumber: | 5042416007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 04/24/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 6148 | LA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 6148 | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 6148 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | 6148 | LA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.