Provider Demographics
NPI:1801143490
Name:BERRONES, SUSANA (LBSW, MSSW)
Entity type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:
Last Name:BERRONES
Suffix:
Gender:F
Credentials:LBSW, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N MALINCHE AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3354
Mailing Address - Country:US
Mailing Address - Phone:956-722-2431
Mailing Address - Fax:956-722-7553
Practice Address - Street 1:1220 N MALINCHE AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3354
Practice Address - Country:US
Practice Address - Phone:956-722-2431
Practice Address - Fax:956-722-7553
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38921104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker