Healthcare Provider Details

I. General information

NPI: 1982914941
Provider Name (Legal Business Name): PAOLA MERCEDES MORENO WAZLAVEK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 CATTLE LN
EL PASO TX
79934-2835
US

IV. Provider business mailing address

4900 CATTLE LN
EL PASO TX
79934-2835
US

V. Phone/Fax

Practice location:
  • Phone: 915-487-6828
  • Fax:
Mailing address:
  • Phone: 915-487-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9414
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111985
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10576
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: