Provider Demographics
NPI:1801232012
Name:ALCAZAR, MARIA DE JESUS (LBSW-IPR)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE JESUS
Last Name:ALCAZAR
Suffix:
Gender:F
Credentials:LBSW-IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6117
Mailing Address - Country:US
Mailing Address - Phone:956-802-1170
Mailing Address - Fax:956-318-0137
Practice Address - Street 1:341 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6117
Practice Address - Country:US
Practice Address - Phone:956-802-1170
Practice Address - Fax:956-318-0137
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37715171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171M00000XMedicaid