Provider Demographics
NPI:1922706100
Name:ZAVALA, SUSANA B (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:B
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:ZAVALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2716 MURPHY DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2716 MURPHY DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4936
Practice Address - Country:US
Practice Address - Phone:817-583-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical