Provider Demographics
NPI:1790836005
Name:ESCOBEDO, BERENICE MAGALLY (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:BERENICE
Middle Name:MAGALLY
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15111 SPRING GLN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5403
Mailing Address - Country:US
Mailing Address - Phone:210-568-0436
Mailing Address - Fax:210-745-2229
Practice Address - Street 1:9006 SAINT JULIEN CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3538
Practice Address - Country:US
Practice Address - Phone:210-682-6530
Practice Address - Fax:210-682-3530
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36621171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator