Provider Demographics
NPI:1093341505
Name:WALTZ, SARAH MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELLE
Last Name:WALTZ
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 1:9100 W IH 10 STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3149
Mailing Address - Country:US
Mailing Address - Phone:210-928-3900
Mailing Address - Fax:219-855-5974
Practice Address - Street 1:4203 WOODCOCK DR STE 216
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1312
Practice Address - Country:US
Practice Address - Phone:210-564-9116
Practice Address - Fax:210-564-9087
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX688671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX68867OtherLICENSED MASTER SOCIAL WOK