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General NPI Number Information
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NPI Number | 1275001257
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Entity Type | Individual
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Provider Name | IRENE CEDILLO LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 2200 DENNISON ST
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City | DALLAS
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State | TX
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Zip | 75212-2460
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Country | US
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Telephone | 972-502-4047
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Fax | 214-266-2296
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Provider Business Mailing Address
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Address Line | 516 HURSTVIEW DR
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City | HURST
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State | TX
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Zip | 76053-6644
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Country | US
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Telephone | 512-903-8182
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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 | 59820
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License Number State | TX
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