Provider Demographics
NPI:1295053999
Name:ESTRADA, EVELYN S (LISW)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:S
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3495
Mailing Address - Country:US
Mailing Address - Phone:505-426-2564
Mailing Address - Fax:505-426-2579
Practice Address - Street 1:1024 SOUTH PACIFIC
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701
Practice Address - Country:US
Practice Address - Phone:505-426-2564
Practice Address - Fax:505-426-2579
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-06341041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool