Provider Demographics
NPI:1629263215
Name:KRAUS, MARY J (LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:KRAUS
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 1:19206 HUEBNER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3146
Mailing Address - Country:US
Mailing Address - Phone:706-247-3515
Mailing Address - Fax:210-787-3808
Practice Address - Street 1:19206 HUEBNER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3146
Practice Address - Country:US
Practice Address - Phone:706-247-3515
Practice Address - Fax:210-787-3808
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40508104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX94963OtherCARELINK
TX191890601Medicaid
TX94963OtherCARELINK
TX8K3121Medicare PIN
TXTXB117039Medicare PIN