Basic Information
| Provider Information | |||||||||
| NPI: | 1487707972 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWARZ | ||||||||
| FirstName: | TERI | ||||||||
| MiddleName: | JAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5001 WESTBANK EXPY | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700722954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043498708 | ||||||||
| FaxNumber: | 5043498703 | ||||||||
| Practice Location | |||||||||
| Address1: | 5001 WESTBANK EXPY | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700722954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043498708 | ||||||||
| FaxNumber: | 5043498703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 02/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 020675 | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1989860 | 05 | LA | MEDICAID |