Individual
DR. JOHN FRANCIS FIDANZA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
6351 MAIN ST, ZACHARY, LA 70791-4038
(225) 306-2000
(225) 658-1282
Mailing address
PO BOX 770, ZACHARY, LA 70791-0770
(225) 306-2000
(225) 658-1249
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
1040MP
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2125958
—
LA
Enumeration date
06/14/2005
Last updated
07/21/2015
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