Healthcare Provider Details

I. General information

NPI: 1033471420
Provider Name (Legal Business Name): KATHRYN MOFFETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MEDICAL CENTER BLVD
MARRERO LA
70072-3144
US

IV. Provider business mailing address

3349 N UNIVERSITY DR SUITE 4
HOLLYWOOD FL
33024-9000
US

V. Phone/Fax

Practice location:
  • Phone: 504-347-0777
  • Fax: 504-341-7240
Mailing address:
  • Phone: 954-885-9500
  • Fax: 954-885-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8241
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: