Provider Demographics
NPI:1275001257
Name:CEDILLO, IRENE (LCSW)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CEDILLO
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 1:516 HURSTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-6644
Mailing Address - Country:US
Mailing Address - Phone:512-903-8182
Mailing Address - Fax:
Practice Address - Street 1:2200 DENNISON ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-2460
Practice Address - Country:US
Practice Address - Phone:972-502-4047
Practice Address - Fax:214-266-2296
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX598201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical