Provider Demographics
NPI:1295457133
Name:CAZARES CERECERO, BRENDA LESLIE (LCSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LESLIE
Last Name:CAZARES CERECERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST. SUITE 170
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3228
Mailing Address - Country:US
Mailing Address - Phone:713-486-6968
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST. SUITE 170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3003
Practice Address - Country:US
Practice Address - Phone:713-486-6968
Practice Address - Fax:713-512-2236
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical