Provider Demographics
NPI:1669654851
Name:CEJA-BRAVO, MARIA (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:
Last Name:CEJA-BRAVO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 ISLA DEL REY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7335
Mailing Address - Country:US
Mailing Address - Phone:714-360-4614
Mailing Address - Fax:
Practice Address - Street 1:6609 ISLA DEL REY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7335
Practice Address - Country:US
Practice Address - Phone:714-360-4614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX62340171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator