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General NPI Number Information
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NPI Number | 1164209086
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Entity Type | Individual
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Provider Name | SUJEY CRISTINA LOERA LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 1515 S BUCKNER BLVD STE 141
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City | DALLAS
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State | TX
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Zip | 75217-1794
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Country | US
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Telephone | 214-396-0349
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Fax |
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Provider Business Mailing Address
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Address Line | 4627 MUNGER AVE APT 203
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City | DALLAS
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State | TX
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Zip | 75204-7305
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Country | US
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Telephone | 720-291-5376
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 104371
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License Number State | TX
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