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NPI Code Detail

MEDICARE: MRS. DENISE B BOOTH MSW, LCSW, LMFT

MEDICARE: MRS. DENISE B BOOTH MSW, LCSW, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker3150LA

General Provider Information

NPI Number : 1194850826
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DENISE B BOOTH MSW, LCSW, LMFT
Provider Business Mailing Address
First Line : 763 NORTH BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70802-5725
Country : US
Telephone Number : 225-387-2287
Fax Number : 225-383-2722
Provider Business Practice Location Address
First Line : 763 NORTH BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70802-5725
Country : US
Telephone Number : 225-387-2287
Fax Number : 225-383-2722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 07/08/2007

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