Healthcare Provider Details

I. General information

NPI: 1922434877
Provider Name (Legal Business Name): ROSA MELIDA THOMASON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N TONTI ST
NEW ORLEANS LA
70119-3549
US

IV. Provider business mailing address

9947 PATTERSON RD
NEW ORLEANS LA
70131-2525
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-9211
  • Fax:
Mailing address:
  • Phone: 504-270-7178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10220
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: