Healthcare Provider Details

I. General information

NPI: 1609707314
Provider Name (Legal Business Name): MICAELA DIAZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10473 OLD HAMMOND HWY
BATON ROUGE LA
70816-8264
US

IV. Provider business mailing address

10473 OLD HAMMOND HWY
BATON ROUGE LA
70816-8264
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-1910
  • Fax: 225-924-1988
Mailing address:
  • Phone: 225-900-8946
  • Fax: 225-924-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number19388
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: