Provider Demographics
NPI:1598330631
Name:CAMARENA, ROSANNA REYES (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:REYES
Last Name:CAMARENA
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 1:6363 DE ZAVALA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2101
Mailing Address - Country:US
Mailing Address - Phone:210-431-6466
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:6363 DE ZAVALA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2101
Practice Address - Country:US
Practice Address - Phone:210-431-6466
Practice Address - Fax:210-431-6470
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-11834104100000X
NM171M00000X
TX1081121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03384314Medicaid