Healthcare Provider Details

I. General information

NPI: 1730546383
Provider Name (Legal Business Name): MODERN DAY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 SEVERN AVE STE 20K
METAIRIE LA
70002-3458
US

IV. Provider business mailing address

3501 SEVERN AVE STE 20K
METAIRIE LA
70002-3458
US

V. Phone/Fax

Practice location:
  • Phone: 504-276-4862
  • Fax:
Mailing address:
  • Phone: 504-276-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANGELIQUE T WILLIAMS
Title or Position: OWNER / MANAGER
Credential: LCSW
Phone: 504-276-4862