Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 5144 | LA |
NPI | 1003465808 |
---|---|
Provider Name | Yvette A Moreno |
First Address | Prairieville, LA 70769-5651 |
Second Address | Baton Rouge, LA 70809-3452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2019 |
Last Update Date | 05/09/2019 |