Healthcare Provider Details

I. General information

NPI: 1306332929
Provider Name (Legal Business Name): NICOLE GOLDIN-MURO MMT, LAC, MT-BC, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 CANAL ST STE 4
NEW ORLEANS LA
70119-6448
US

IV. Provider business mailing address

4534 OWENS BLVD
NEW ORLEANS LA
70122-1223
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-2232
  • Fax:
Mailing address:
  • Phone: 504-234-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4156
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: