Provider Demographics
NPI:1619559598
Name:HEAD, SYDNEY RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:RAE
Last Name:HEAD
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 1:4004 REYNOSA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-4339
Mailing Address - Country:US
Mailing Address - Phone:325-370-3364
Mailing Address - Fax:
Practice Address - Street 1:12308 TWIN CREEKS RD B103
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652
Practice Address - Country:US
Practice Address - Phone:325-370-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker