Provider Demographics
NPI:1659797553
Name:HENRIQUES, RANDI
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:HENRIQUES
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 1:6752 GENERAL HAIG ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-4019
Mailing Address - Country:US
Mailing Address - Phone:504-339-3597
Mailing Address - Fax:
Practice Address - Street 1:6752 GENERAL HAIG ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-4019
Practice Address - Country:US
Practice Address - Phone:504-339-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3946104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker