Provider Demographics
NPI:1639271067
Name:SALDIVAR, ENRIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:SALDIVAR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 UNIVERSITY DR
Mailing Address - Street 2:SUITE #105
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2168
Mailing Address - Country:US
Mailing Address - Phone:817-360-2983
Mailing Address - Fax:817-386-5880
Practice Address - Street 1:601 UNIVERSITY DR
Practice Address - Street 2:SUITE #105
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2168
Practice Address - Country:US
Practice Address - Phone:817-360-2983
Practice Address - Fax:817-386-5880
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195828202Medicaid
TX0007HCOtherBLUE CROSS BLUE SHIELD
TX7759307OtherAETNA BEHAV. HEALTH
TX0007HCOtherBLUE CROSS BLUE SHIELD