Provider Demographics
NPI:1518225457
Name:CERVANTES, ANGELICA NANEZ (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:NANEZ
Last Name:CERVANTES
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 1:1115 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-4505
Mailing Address - Country:US
Mailing Address - Phone:210-533-3504
Mailing Address - Fax:
Practice Address - Street 1:1115 MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-4505
Practice Address - Country:US
Practice Address - Phone:210-533-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-29
Last Update Date:2012-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical