Provider Demographics
NPI:1891853693
Name:MIRRER, PATRICIA DARLING (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DARLING
Last Name:MIRRER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:DARLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11107 WURZBACH ROAD
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2570
Mailing Address - Country:US
Mailing Address - Phone:210-690-8377
Mailing Address - Fax:210-690-4312
Practice Address - Street 1:11107 WURZBACH ROAD
Practice Address - Street 2:SUITE 604
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2570
Practice Address - Country:US
Practice Address - Phone:210-690-8377
Practice Address - Fax:210-690-4312
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00239PMedicare ID - Type Unspecified