Provider Demographics
NPI:1720418098
Name:RICALDE, EDGAR (LMSW)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:RICALDE
Suffix:
Gender:M
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:PO BOX 2452
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78044-2452
Mailing Address - Country:US
Mailing Address - Phone:956-251-1455
Mailing Address - Fax:210-568-6562
Practice Address - Street 1:521A TEAKWOOD LN
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3751
Practice Address - Country:US
Practice Address - Phone:956-251-1455
Practice Address - Fax:210-568-6562
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57805104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker