Provider Demographics
NPI:1528006897
Name:BALDERAS, CARMEN (LSCW-DCSW)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:BALDERAS
Suffix:
Gender:F
Credentials:LSCW-DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 WURZBACH RD
Mailing Address - Street 2:SUITE 1504
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4801
Mailing Address - Country:US
Mailing Address - Phone:210-647-7907
Mailing Address - Fax:210-647-7805
Practice Address - Street 1:7272 WURZBACH RD
Practice Address - Street 2:SUITE 1504
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4801
Practice Address - Country:US
Practice Address - Phone:210-647-7907
Practice Address - Fax:210-647-7805
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX025361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063978301Medicaid
TX00S11VOtherBC/BS
TX00S11VOtherBC/BS