Provider Demographics
NPI:1356649735
Name:DE LUNA, SANJUANITA (LMSW-IPR)
Entity Type:Individual
Prefix:
First Name:SANJUANITA
Middle Name:
Last Name:DE LUNA
Suffix:
Gender:F
Credentials:LMSW-IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8642 PUERTO ESCONDIDO
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6204
Mailing Address - Country:US
Mailing Address - Phone:956-220-8037
Mailing Address - Fax:
Practice Address - Street 1:6510 POLARIS DR
Practice Address - Street 2:SUITE 2, UNIT 10
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2053
Practice Address - Country:US
Practice Address - Phone:956-284-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19571171M00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator