Provider Demographics
NPI:1568911840
Name:ESTRADA, ABBY (LCSW)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:ESTRADA
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 1:9901 BRODIE LANE
Mailing Address - Street 2:SUITE 160 PMB523
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5892
Mailing Address - Country:US
Mailing Address - Phone:940-441-3826
Mailing Address - Fax:
Practice Address - Street 1:9901 BRODIE LANE
Practice Address - Street 2:SUITE 160 PMB523
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5892
Practice Address - Country:US
Practice Address - Phone:940-441-3826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66316101YM0800X
104100000X
LA14065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1548839Medicaid