Provider Demographics
NPI:1205493699
Name:WARNER, MOLENA DANYEL (RSW)
Entity type:Individual
Prefix:MISS
First Name:MOLENA
Middle Name:DANYEL
Last Name:WARNER
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 1:5208 WESTGROVE PARK
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8596
Mailing Address - Country:US
Mailing Address - Phone:504-495-2310
Mailing Address - Fax:
Practice Address - Street 1:401 WHITNEY AVE STE 409
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2503
Practice Address - Country:US
Practice Address - Phone:504-362-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010781773171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator