Provider Demographics
NPI:1164667655
Name:BOUDREAU, CARMEN (LBSW)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:CASAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0087
Mailing Address - Country:US
Mailing Address - Phone:210-358-9174
Mailing Address - Fax:210-358-5753
Practice Address - Street 1:527 N LEONA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3110
Practice Address - Country:US
Practice Address - Phone:210-358-3620
Practice Address - Fax:210-358-5955
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator