MEDICARE: LOUCRECIA ELMORE

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	SW22942	FL

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	:	1053729145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUCRECIA ELMORE

Provider Business Mailing Address
First Line	:	11706 BRIGHTON KNOLL LOOP
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-2147
Country	:	US
Telephone Number	:	813-318-2163
Fax Number	:

Provider Business Practice Location Address
First Line	:	8526 CATALINA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1700
Country	:	US
Telephone Number	:	813-690-1016
Fax Number	:	813-602-0157

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

Provider Enumeration Date	:	08/01/2014
Last Update Date	:	04/24/2024

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Directions to “ LOUCRECIA ELMORE ” Practice Location

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