Healthcare Provider Details

I. General information

NPI: 1700323755
Provider Name (Legal Business Name): NICOSIA LATRICE JONES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 MCGEHEE DR
BATON ROUGE LA
70815
US

IV. Provider business mailing address

411 COLONIAL DR
BATON ROUGE LA
70806-6506
US

V. Phone/Fax

Practice location:
  • Phone: 225-272-5271
  • Fax:
Mailing address:
  • Phone: 225-926-9706
  • Fax: 225-926-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10201
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: