MEDICARE: MRS. THOMASENA LAMENA MCNUTT LCSW

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
1	1041C0700X	Clinical Social Worker	2058-C	AR
2	1041C0700X	Clinical Social Worker	LW61221460	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285754960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THOMASENA LAMENA MCNUTT LCSW

Provider Business Mailing Address
First Line	:	4700 W COMMERCIAL DR
Second Line	:	SUITE B1
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7068
Country	:	US
Telephone Number	:	501-727-3100
Fax Number	:	501-727-3100

Provider Business Practice Location Address
First Line	:	4700W COMMERCIAL DR B
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8089
Country	:	US
Telephone Number	:	501-727-3100
Fax Number	:	501-727-3100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	10/09/2023

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