MEDICARE: ERICA BOOKER LICENSED CLINICAL SOCIAL WORKER, INC.

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

General Provider Information

NPI Number	:	1639898935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERICA BOOKER LICENSED CLINICAL SOCIAL WORKER, INC.

Provider Business Mailing Address
First Line	:	2060D E AVENIDA DE LOS ARBOLES # 148
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-1376
Country	:	US
Telephone Number	:	805-870-5155
Fax Number	:

Provider Business Practice Location Address
First Line	:	2277 TOWNSGATE RD STE 102
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2415
Country	:	US
Telephone Number	:	805-870-5155
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	ERICA BOOKER
Credential	:	LCSW
Telephone Number	:	805-870-5155

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/22/2022

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