Provider Demographics
NPI:1376729913
Name:GALVAN-RODRIGUEZ, JUAN GERARDO (LCSW-S)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:GERARDO
Last Name:GALVAN-RODRIGUEZ
Suffix:
Gender:M
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 N MEADOW AVE STE I
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-8701
Mailing Address - Country:US
Mailing Address - Phone:956-744-5137
Mailing Address - Fax:956-462-5003
Practice Address - Street 1:1414 N MEADOW AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-8701
Practice Address - Country:US
Practice Address - Phone:956-744-5137
Practice Address - Fax:956-462-5003
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX529251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty