Desirae Nicolle Vidaurri, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810005697 Issued in VA

Practice address

2400 Canal St
New Orleans, LA 70119-6535

Phone

(504) 507-2000

NPI assigned

Jun 2, 2017

Last updated

Jun 2, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Desriae Nicolle Boldt Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496361600000",
    "number": "1073041026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 ELK PL APT 1507",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701122636",
            "telephone_number": "512-538-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 CANAL ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701196535",
            "telephone_number": "504-507-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDAURRI",
        "first_name": "DESIRAE",
        "middle_name": "NICOLLE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-02",
        "last_updated": "2017-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DESRIAE",
            "last_name": "BOLDT",
            "middle_name": "NICOLLE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Annetrist Vigne

• Clinical Psychologist in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Clinical Psychologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.