Healthcare Provider Details

I. General information

NPI: 1760391676
Provider Name (Legal Business Name): CLAUDIA BRISENO GORMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PINSON RD STE M
FORNEY TX
75126-9774
US

IV. Provider business mailing address

4009 SCHWARTZ AVE
FORT WORTH TX
76106-3930
US

V. Phone/Fax

Practice location:
  • Phone: 214-267-9001
  • Fax:
Mailing address:
  • Phone: 817-770-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118585
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: