Provider Demographics
NPI:1467710939
Name:FARIAS, ELVA (MSSW, LBSW-IPR)
Entity Type:Individual
Prefix:
First Name:ELVA
Middle Name:
Last Name:FARIAS
Suffix:
Gender:F
Credentials:MSSW, LBSW-IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:GRULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78548-0565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:606 BENITO ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6477
Practice Address - Country:US
Practice Address - Phone:956-573-4370
Practice Address - Fax:956-263-1034
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28442171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator