Provider Demographics
NPI:1649404872
Name:CAVAZOS, STEPHANIE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CAVAZOS
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:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-0907
Mailing Address - Country:US
Mailing Address - Phone:361-676-6013
Mailing Address - Fax:361-987-2892
Practice Address - Street 1:1227 LIVE OAK DR
Practice Address - Street 2:
Practice Address - City:INEZ
Practice Address - State:TX
Practice Address - Zip Code:77968-3645
Practice Address - Country:US
Practice Address - Phone:361-676-6013
Practice Address - Fax:361-987-2892
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36313104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker