Basic Information
| Provider Information | |||||||||
| NPI: | 1760923049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUNEY | ||||||||
| FirstName: | DERRICK | ||||||||
| MiddleName: | DWIGHT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1542 TULANE AVE RM 231 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045686004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1542 TULANE AVE RM 231 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045686004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 313116 | LA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0800X | 313116 | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.