MEDICARE: ENRICKA THOMAS LCSW-BACS

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	5238	LA

General Provider Information

NPI Number	:	1104293547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRICKA THOMAS LCSW-BACS

Provider Business Mailing Address
First Line	:	11422 SAINT GEORGE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70811-1351
Country	:	US
Telephone Number	:	225-270-5354
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 FLORIDA AVE SW
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4947
Country	:	US
Telephone Number	:	225-665-0473
Fax Number	:

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

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	08/03/2023

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