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NPI Code Detail

MEDICARE: ROCIO PONCE LCSW

MEDICARE:   ROCIO  PONCE  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker107851TX

General Provider Information

NPI Number : 1174184485
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROCIO PONCE LCSW
Provider Business Mailing Address
First Line : 1545 W MOCKINGBIRD LN
Second Line :
City : DALLAS
State : TX
Zip : 75235-5014
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1314 GRIGSBY AVE
Second Line :
City : DALLAS
State : TX
Zip : 75204-6873
Country : US
Telephone Number : 469-600-6654
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2019
Last Update Date : 10/08/2024

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Directions to “ ROCIO PONCE LCSW” Practice Location

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