Healthcare Provider Details

I. General information

NPI: 1225322787
Provider Name (Legal Business Name): DORA ANN CISNEROS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 FM 2920 RD
SPRING TX
77388-4123
US

IV. Provider business mailing address

26325 NORTHGATE CROSSING BLVD APT 812
SPRING TX
77373-5641
US

V. Phone/Fax

Practice location:
  • Phone: 281-528-2810
  • Fax:
Mailing address:
  • Phone: 713-702-8873
  • Fax: 713-583-9144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number50914
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: