Provider Demographics
NPI:1821215740
Name:CAVAZOS, ROSALIE IRIS (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:IRIS
Last Name:CAVAZOS
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 1:1002 E FLYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-4361
Mailing Address - Country:US
Mailing Address - Phone:956-428-0623
Mailing Address - Fax:
Practice Address - Street 1:1002 E FLYNN AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-4361
Practice Address - Country:US
Practice Address - Phone:956-428-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08024104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker