Provider Demographics
NPI:1912144940
Name:QUINTANILLA, CARMELA PRADO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARMELA
Middle Name:PRADO
Last Name:QUINTANILLA
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:PO BOX 81082
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-1082
Mailing Address - Country:US
Mailing Address - Phone:361-442-8178
Mailing Address - Fax:
Practice Address - Street 1:6317 FITZHUGH DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3005
Practice Address - Country:US
Practice Address - Phone:361-442-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical