Provider Demographics
NPI:1700026689
Name:PASTRANO, ROSE RIVERA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:RIVERA
Last Name:PASTRANO
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 1:11746 OCEAN SPGS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2658
Mailing Address - Country:US
Mailing Address - Phone:210-396-1197
Mailing Address - Fax:210-733-0564
Practice Address - Street 1:819 S GENERAL MCMULLEN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3138
Practice Address - Country:US
Practice Address - Phone:210-396-1157
Practice Address - Fax:210-733-0564
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29308104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker