Provider Demographics
NPI:1114955325
Name:BURGOS-CADENA, IRENE (LCSW)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BURGOS-CADENA
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 1:1514 N ZARAGOZA RD
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7905
Mailing Address - Country:US
Mailing Address - Phone:915-857-8242
Mailing Address - Fax:877-587-9452
Practice Address - Street 1:1514 N ZARAGOZA RD
Practice Address - Street 2:SUITE A-4
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7905
Practice Address - Country:US
Practice Address - Phone:915-857-8242
Practice Address - Fax:877-587-9452
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86545QOtherBXBS
TX174410404Medicaid
TX174410401Medicaid
TX0067MEOtherBXBS
TX86545QOtherBXBS