Provider Demographics
NPI:1245454800
Name:ELIZONDO, ROLANDO BENITEZ JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:BENITEZ
Last Name:ELIZONDO
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SUL ROSS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5116
Mailing Address - Country:US
Mailing Address - Phone:713-364-6755
Mailing Address - Fax:
Practice Address - Street 1:310 SUL ROSS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5116
Practice Address - Country:US
Practice Address - Phone:713-364-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX398511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical