Provider Demographics
NPI:1144283599
Name:CHAFETZ, MICHAEL D (PHD, ABPP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:CHAFETZ
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 GENERAL DEGAULLE DR
Mailing Address - Street 2:SUITE 3044
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6757
Mailing Address - Country:US
Mailing Address - Phone:336-659-8536
Mailing Address - Fax:
Practice Address - Street 1:3520 GENERAL DEGAULLE DR
Practice Address - Street 2:SUITE 3044
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6757
Practice Address - Country:US
Practice Address - Phone:336-659-8536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA762103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1695513Medicaid
LA1695513Medicaid
LA5X182Medicare ID - Type Unspecified