Provider Demographics
NPI:1891902441
Name:PHEANIS, JUDITH (LBSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:PHEANIS
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 1:5836 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4309
Mailing Address - Country:US
Mailing Address - Phone:956-739-7692
Mailing Address - Fax:956-994-1283
Practice Address - Street 1:4200 N RAUL LONGORIA RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3680
Practice Address - Country:US
Practice Address - Phone:956-783-9433
Practice Address - Fax:956-783-9028
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker