Provider Demographics
NPI:1740330620
Name:MUNIZ, DORIS JOYCE (LCSW)
Entity type:Individual
Prefix:MS
First Name:DORIS
Middle Name:JOYCE
Last Name:MUNIZ
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 1:1009 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1952
Mailing Address - Country:US
Mailing Address - Phone:210-724-6979
Mailing Address - Fax:210-525-1469
Practice Address - Street 1:4242 MEDICAL DR
Practice Address - Street 2:STE 7200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5644
Practice Address - Country:US
Practice Address - Phone:210-724-6979
Practice Address - Fax:210-525-1469
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX051411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0371395-02Medicaid
TX610419Medicare ID - Type Unspecified