Healthcare Provider Details

I. General information

NPI: 1649643032
Provider Name (Legal Business Name): TRINNA STANFORD MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 ELYSIAN FIELDS AVE
NEW ORLEANS LA
70122-4245
US

IV. Provider business mailing address

2729 BAYOU COOK DR
MARRERO LA
70072-8502
US

V. Phone/Fax

Practice location:
  • Phone: 504-265-0996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6723
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: