Basic Information
Provider Information
NPI: 1396238044
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBINSON-JACKSON
FirstName: CHARLETTE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 S BROAD ST STE 7
Address2:  
City: NEW ORLEANS
State: LA
PostalCode: 701196447
CountryCode: US
TelephoneNumber: 5043099991
FaxNumber: 5048210609
Practice Location
Address1: 1125 N TONTI ST
Address2:  
City: NEW ORLEANS
State: LA
PostalCode: 701193598
CountryCode: US
TelephoneNumber: 5048219211
FaxNumber: 5043715029
Other Information
ProviderEnumerationDate: 06/07/2018
LastUpdateDate: 11/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X LAY Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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