MEDICARE: JAY MAIORANA LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	763	LA

General Provider Information

NPI Number	:	1801828132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY MAIORANA LAC

Provider Business Mailing Address
First Line	:	1809 W AIRLINE HWY
Second Line	:
City	:	LA PLACE
State	:	LA
Zip	:	70068-3336
Country	:	US
Telephone Number	:	985-652-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 W AIRLINE HWY
Second Line	:
City	:	LA PLACE
State	:	LA
Zip	:	70068-3336
Country	:	US
Telephone Number	:	985-652-8444
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	05/01/2015

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Directions to “ JAY MAIORANA LAC” Practice Location

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