Basic Information
| Provider Information | |||||||||
| NPI: | 1104358241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | DERIC | ||||||||
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| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4936 TOURO ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701224072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046218602 | ||||||||
| FaxNumber: | 5046093366 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 BARONNE ST STE 304 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701131054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048148001 | ||||||||
| FaxNumber: | 5046093366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.