Provider Demographics
NPI:1306223938
Name:FREJ-FLORES, ANNALISA (LMSW)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:FREJ-FLORES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E SAN ANTONIO AVE
Mailing Address - Street 2:LL 108
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-2419
Mailing Address - Country:US
Mailing Address - Phone:915-834-8200
Mailing Address - Fax:915-834-8299
Practice Address - Street 1:500 E SAN ANTONIO AVE
Practice Address - Street 2:LL 108
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-2419
Practice Address - Country:US
Practice Address - Phone:915-834-8200
Practice Address - Fax:915-834-8299
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51960104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker