Basic Information
| Provider Information | |||||||||
| NPI: | 1700219557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANAGAN | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 TULANE AVE SUITE 500 | ||||||||
| Address2: | NO AIDS TASK FORCE | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048212601 | ||||||||
| FaxNumber: | 5042673014 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 TULANE AVE SUITE 500 | ||||||||
| Address2: | NO AIDS TASK FORCE | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048212601 | ||||||||
| FaxNumber: | 5042673014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2013 | ||||||||
| LastUpdateDate: | 08/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 11552 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.