Provider Demographics
NPI:1770990202
Name:GAMEZ, MICAH ALIZANDRA (LCSW 119913)
Entity type:Individual
Prefix:MRS
First Name:MICAH
Middle Name:ALIZANDRA
Last Name:GAMEZ
Suffix:
Gender:F
Credentials:LCSW 119913
Other - Prefix:MRS
Other - First Name:MICAH
Other - Middle Name:ALIZANDRA
Other - Last Name:MANZANILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 W MARTIN ST # MS 49-2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-0903
Mailing Address - Country:US
Mailing Address - Phone:210-358-5909
Mailing Address - Fax:210-358-5940
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-4000
Practice Address - Fax:210-358-4775
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical