Provider Demographics
NPI:1528565918
Name:MOSES, DAMIEN ANTHONY X (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:DAMIEN
Middle Name:ANTHONY
Last Name:MOSES
Suffix:X
Gender:M
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 SEVERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5941
Mailing Address - Country:US
Mailing Address - Phone:504-454-3740
Mailing Address - Fax:504-454-3738
Practice Address - Street 1:2540 SEVERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-454-3740
Practice Address - Fax:504-454-3738
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA101YM0800XMedicaid