Provider Demographics
NPI:1013411446
Name:BOOKER, RENEE (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BOOKER
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W ESPLANADE AVE APT B103
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3972
Mailing Address - Country:US
Mailing Address - Phone:504-388-1944
Mailing Address - Fax:
Practice Address - Street 1:123 W ESPLANADE AVE APT B103
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3972
Practice Address - Country:US
Practice Address - Phone:504-388-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker