Basic Information
| Provider Information | |||||||||
| NPI: | 1417118928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REINE | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3616 S I 10 SERVICE RD W | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700011874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048385257 | ||||||||
| FaxNumber: | 5048385284 | ||||||||
| Practice Location | |||||||||
| Address1: | 3616 S I 10 SERVICE RD W | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700011874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048385257 | ||||||||
| FaxNumber: | 5048385284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2008 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1111 | LA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | 7652 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.