MEDICARE: ABBY ESTRADA 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
1	101YM0800X	Mental Health Counselor	66316	TX
2	104100000X	Social Worker
3	101YM0800X	Mental Health Counselor	14065	LA

General Provider Information

NPI Number	:	1568911840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY ESTRADA LCSW

Provider Business Mailing Address
First Line	:	9901 BRODIE LANE
Second Line	:	SUITE 160 PMB523
City	:	AUSTIN
State	:	TX
Zip	:	78748-5892
Country	:	US
Telephone Number	:	940-441-3826
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 BRODIE LANE
Second Line	:	SUITE 160 PMB523
City	:	AUSTIN
State	:	TX
Zip	:	78748-5892
Country	:	US
Telephone Number	:	940-441-3826
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	08/24/2021

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