Healthcare Provider Details

I. General information

NPI: 1700996402
Provider Name (Legal Business Name): JOSE ANGEL RENDON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 STONEBRIDGE BLVD
NEW CASTLE DE
19720-6741
US

IV. Provider business mailing address

2106 TREASURE HILLS BLVD
HARLINGEN TX
78550-8736
US

V. Phone/Fax

Practice location:
  • Phone: 832-338-0940
  • Fax:
Mailing address:
  • Phone: 956-366-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number39126
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-001977
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: