Provider Demographics
NPI:1043677941
Name:BOOZE, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BOOZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 GRASSY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3772
Mailing Address - Country:US
Mailing Address - Phone:318-623-4563
Mailing Address - Fax:
Practice Address - Street 1:1180 HIGHWAY 51 STE A
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-6365
Practice Address - Country:US
Practice Address - Phone:985-467-0730
Practice Address - Fax:985-467-0674
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health