Provider Demographics
NPI:1083654537
Name:NUNEZ, SAMUEL (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
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:PO BOX 371113
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79937-1113
Mailing Address - Country:US
Mailing Address - Phone:915-594-8685
Mailing Address - Fax:866-596-6125
Practice Address - Street 1:10761 PEBBLE HILLS BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-2037
Practice Address - Country:US
Practice Address - Phone:915-594-8685
Practice Address - Fax:866-596-6125
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-07343104100000X
TX020671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040468307Medicaid
TX040468308Medicaid
NM99436311Medicaid