Basic Information
| Provider Information | |||||||||
| NPI: | 1174861785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAINEY | ||||||||
| FirstName: | MAURICE | ||||||||
| MiddleName: | JAMES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2618 AUBRY ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701192208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049431625 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2626 CHARLES DR | ||||||||
| Address2: | |||||||||
| City: | CHALMETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700433779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042784006 | ||||||||
| FaxNumber: | 5042784007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2013 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.