MEDICARE: MONIQUE JEANMARIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		LA

General Provider Information

NPI Number	:	1346786951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE JEANMARIE

Provider Business Mailing Address
First Line	:	4935 CARDENAS DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-3740
Country	:	US
Telephone Number	:	504-460-0915
Fax Number	:

Provider Business Practice Location Address
First Line	:	8080 CROWDER BLVD
Second Line	:	STE D
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-1077
Country	:	US
Telephone Number	:	504-460-0915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	01/06/2017

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Directions to “ MONIQUE JEANMARIE ” Practice Location

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