Provider Demographics
NPI:1164632394
Name:DE ANDA, ROBERTO (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:DE ANDA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7707
Mailing Address - Country:US
Mailing Address - Phone:956-574-0951
Mailing Address - Fax:956-574-0951
Practice Address - Street 1:235 FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7707
Practice Address - Country:US
Practice Address - Phone:956-574-0951
Practice Address - Fax:956-574-0951
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional