Provider Demographics
NPI:1619385515
Name:SOTO, ANDRA R (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:R
Last Name:SOTO
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 1:107 FANNIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5218
Mailing Address - Country:US
Mailing Address - Phone:737-243-4531
Mailing Address - Fax:
Practice Address - Street 1:107 FANNIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-5218
Practice Address - Country:US
Practice Address - Phone:737-243-4531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA959691041C0700X
TX1038501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical