Provider Demographics
NPI:1164700365
Name:CORONADO, MINERVA G (LMSW-AP)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:G
Last Name:CORONADO
Suffix:
Gender:F
Credentials:LMSW-AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 E PRICE RD STE B2
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3578
Mailing Address - Country:US
Mailing Address - Phone:956-550-0499
Mailing Address - Fax:956-550-0550
Practice Address - Street 1:95 E PRICE RD STE B2
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3578
Practice Address - Country:US
Practice Address - Phone:956-550-0499
Practice Address - Fax:956-550-0550
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 172V00000X
TX1009712251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Yes172V00000XOther Service ProvidersCommunity Health Worker