Provider Demographics
NPI:1407220007
Name:CUEVAS-MENDOZA, CARMEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:
Last Name:CUEVAS-MENDOZA
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 1:1284 FARM RD 665
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-6952
Mailing Address - Country:US
Mailing Address - Phone:361-664-4151
Mailing Address - Fax:361-668-0045
Practice Address - Street 1:1284 FARM RD 665
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-6952
Practice Address - Country:US
Practice Address - Phone:361-664-4151
Practice Address - Fax:361-668-0045
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX504751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical