Provider Demographics
NPI:1164209086
Name:LOERA, SUJEY CRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:SUJEY
Middle Name:CRISTINA
Last Name:LOERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUJEY
Other - Middle Name:CRISTINA
Other - Last Name:LOERA OLAGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4627 MUNGER AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-7305
Mailing Address - Country:US
Mailing Address - Phone:720-291-5376
Mailing Address - Fax:
Practice Address - Street 1:1515 S BUCKNER BLVD STE 141
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-1794
Practice Address - Country:US
Practice Address - Phone:214-396-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1043711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical