Provider Demographics
NPI:1386686657
Name:FARIAS, LUISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:FARIAS
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 1:12915 JONES MALTSBERGER RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4282
Mailing Address - Country:US
Mailing Address - Phone:210-592-9964
Mailing Address - Fax:210-348-8990
Practice Address - Street 1:12915 JONES MALTSBERGER RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4282
Practice Address - Country:US
Practice Address - Phone:210-592-9964
Practice Address - Fax:210-348-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX286561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170273001Medicaid
TX170273001Medicaid