Provider Demographics
NPI:1225364391
Name:OLIVAREZ, JOSE NOE SR (LBSW, IPR)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:NOE
Last Name:OLIVAREZ
Suffix:SR
Gender:M
Credentials:LBSW, IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25224 N KANSAS CITY RD
Mailing Address - Street 2:LA FERIA
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559-4513
Mailing Address - Country:US
Mailing Address - Phone:956-893-3144
Mailing Address - Fax:956-565-6265
Practice Address - Street 1:25224 N KANSAS CITY RD
Practice Address - Street 2:LA FERIA
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559-4513
Practice Address - Country:US
Practice Address - Phone:956-893-3144
Practice Address - Fax:956-565-6265
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23077171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator