Provider Demographics
NPI:1033822200
Name:BOOTEN, JESSICA SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUE
Last Name:BOOTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 HARMONY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2312
Mailing Address - Country:US
Mailing Address - Phone:504-407-5464
Mailing Address - Fax:
Practice Address - Street 1:817 HARMONY ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2312
Practice Address - Country:US
Practice Address - Phone:504-407-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA126331041C0700X
NCC0110331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical