Provider Demographics
NPI:1235508946
Name:TISCARENO, ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:TISCARENO
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 1:2400 TRAWOOD DR
Mailing Address - Street 2:SUITE 301-B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4168
Mailing Address - Country:US
Mailing Address - Phone:915-599-6690
Mailing Address - Fax:915-592-7168
Practice Address - Street 1:2400 TRAWOOD DR
Practice Address - Street 2:SUITE 301-B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4168
Practice Address - Country:US
Practice Address - Phone:915-599-6690
Practice Address - Fax:915-592-7168
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical