Provider Demographics
NPI:1518059633
Name:JUAREZ, ROBERTO JESUS (LMFT)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:JESUS
Last Name:JUAREZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 RUSTIC MNR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3901
Mailing Address - Country:US
Mailing Address - Phone:956-592-7985
Mailing Address - Fax:
Practice Address - Street 1:5302 RUSTIC MNR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3901
Practice Address - Country:US
Practice Address - Phone:956-592-7985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4603106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist