Provider Demographics
NPI:1093016420
Name:BUSTAMANTE, ADRIANA ELISSA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ADRIANA
Middle Name:ELISSA
Last Name:BUSTAMANTE
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 1:1003 JUSTIN LN
Mailing Address - Street 2:APT 1077
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-2662
Mailing Address - Country:US
Mailing Address - Phone:512-203-2705
Mailing Address - Fax:
Practice Address - Street 1:1003 JUSTIN LN
Practice Address - Street 2:APT 1077
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-2662
Practice Address - Country:US
Practice Address - Phone:512-203-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX410421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical