Healthcare Provider Details

I. General information

NPI: 1598330631
Provider Name (Legal Business Name): ROSANNA REYES CAMARENA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 MONTANA AVE STE 204
EL PASO TX
79902-5660
US

IV. Provider business mailing address

201 E MAIN DR
EL PASO TX
79901-1340
US

V. Phone/Fax

Practice location:
  • Phone: 915-747-3510
  • Fax:
Mailing address:
  • Phone: 915-887-3410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108112
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-11834
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: