Healthcare Provider Details

I. General information

NPI: 1700966504
Provider Name (Legal Business Name): MYA THORNBURGH MSW, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 DESOTO ST
NEW ORLEANS LA
70119-3331
US

IV. Provider business mailing address

2826 DESOTO ST
NEW ORLEANS LA
70119-3331
US

V. Phone/Fax

Practice location:
  • Phone: 504-259-3030
  • Fax:
Mailing address:
  • Phone: 504-259-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8252
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: