Provider Demographics
NPI:1003896085
Name:MORAN, SARAH B (LCSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:B
Last Name:MORAN
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N CAUSEWAY BLVD
Mailing Address - Street 2:#32
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3243
Mailing Address - Country:US
Mailing Address - Phone:985-626-8100
Mailing Address - Fax:985-626-5900
Practice Address - Street 1:1011 N CAUSEWAY BLVD
Practice Address - Street 2:#32
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3243
Practice Address - Country:US
Practice Address - Phone:985-626-8100
Practice Address - Fax:985-626-5900
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C483Medicare ID - Type Unspecified