Provider Demographics
NPI:1396289583
Name:MOORE, ANJEL
Entity type:Individual
Prefix:
First Name:ANJEL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 STUMPF BLVD
Mailing Address - Street 2:BLDG. 7, SUITE 10
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-249-2239
Mailing Address - Fax:504-308-1400
Practice Address - Street 1:1799 STUMPF BLVD.
Practice Address - Street 2:BLDG. 7, SUITE 10
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:504-249-2239
Practice Address - Fax:504-308-1400
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator