Provider Demographics
NPI:1154890937
Name:TESSITORE, BRIAN (CIT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:TESSITORE
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 WEYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1481
Mailing Address - Country:US
Mailing Address - Phone:225-361-0899
Mailing Address - Fax:225-367-1422
Practice Address - Street 1:2325 WEYMOUTH DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1481
Practice Address - Country:US
Practice Address - Phone:225-361-0899
Practice Address - Fax:225-367-1422
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4099101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)