Healthcare Provider Details

I. General information

NPI: 1194428896
Provider Name (Legal Business Name): BRENDA ZAVALA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 AVENUE I
ROSENBERG TX
77471-2641
US

IV. Provider business mailing address

8730 ROWEN CT
NEEDVILLE TX
77461-8100
US

V. Phone/Fax

Practice location:
  • Phone: 281-498-4673
  • Fax:
Mailing address:
  • Phone: 979-997-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103656
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: