Provider Demographics
NPI:1205018827
Name:LEONY-CARRETE, AMELIA H (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:H
Last Name:LEONY-CARRETE
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 1:1855 TRAWOOD DR.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3112
Mailing Address - Country:US
Mailing Address - Phone:915-593-2000
Mailing Address - Fax:915-593-2002
Practice Address - Street 1:1855 TRAWOOD DR.
Practice Address - Street 2:SUITE 107
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3112
Practice Address - Country:US
Practice Address - Phone:915-593-2000
Practice Address - Fax:915-593-2002
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX388531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211264101&211264102Medicaid
TX614314Medicare PIN