Provider Demographics
NPI:1689344491
Name:LEZAMA, ESTEFFANIA ADRIANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ESTEFFANIA
Middle Name:ADRIANA
Last Name:LEZAMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6202 GASTON AVE # 4B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-7306
Mailing Address - Country:US
Mailing Address - Phone:915-274-4598
Mailing Address - Fax:
Practice Address - Street 1:8350 N CENTRAL EXPY STE 1275
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1614
Practice Address - Country:US
Practice Address - Phone:214-302-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38843103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist