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General NPI Number Information
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NPI Number | 1730546383
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Entity Type | Organization
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Legal Business Name | MODERN DAY THERAPY LLC
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 3501 SEVERN AVE STE 20K
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City | METAIRIE
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State | LA
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Zip | 70002-3458
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Country | US
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Telephone | 504-276-4862
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 SEVERN AVE STE 20K
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City | METAIRIE
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State | LA
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Zip | 70002-3458
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Country | US
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Telephone | 504-276-4862
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Fax |
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Authorized Official
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Title or Position | OWNER / MANAGER
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Name | ANGELIQUE T WILLIAMS
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Credential | LCSW
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Telephone | 504-276-4862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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