Provider Demographics
NPI:1114382645
Name:MOODY, TREENA BLAND (RSW)
Entity Type:Individual
Prefix:
First Name:TREENA
Middle Name:BLAND
Last Name:MOODY
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 ELYSIAN FIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117
Mailing Address - Country:US
Mailing Address - Phone:504-821-2601
Mailing Address - Fax:504-814-6047
Practice Address - Street 1:1631 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117
Practice Address - Country:US
Practice Address - Phone:504-821-2601
Practice Address - Fax:504-814-6047
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6823171M00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator