Provider Demographics
NPI:1457439598
Name:ANDERSON, RONDA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:MARIE
Last Name:ANDERSON
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 1:6426 ROYAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-1636
Mailing Address - Country:US
Mailing Address - Phone:210-897-9728
Mailing Address - Fax:210-949-3326
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:SOCIAL WORK - 122
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:210-949-3326
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177463001Medicaid