Provider Demographics
NPI:1750530564
Name:TREVINO, DORA ALICIA (LCSW)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:ALICIA
Last Name:TREVINO
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 1:2655 EASY ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7385
Mailing Address - Country:US
Mailing Address - Phone:956-682-4151
Mailing Address - Fax:956-682-4154
Practice Address - Street 1:2655 EASY ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7385
Practice Address - Country:US
Practice Address - Phone:956-682-4151
Practice Address - Fax:956-682-4154
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX501911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613949Medicare PIN