MEDICARE: IRENE BURGOS-CADENA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	35831	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86545Q	OTHER	TX	BXBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0067ME	OTHER	TX	BXBS

General Provider Information

NPI Number	:	1114955325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE BURGOS-CADENA LCSW

Provider Business Mailing Address
First Line	:	1514 N ZARAGOZA RD
Second Line	:	SUITE A-4
City	:	EL PASO
State	:	TX
Zip	:	79936-7905
Country	:	US
Telephone Number	:	915-857-8242
Fax Number	:	877-587-9452

Provider Business Practice Location Address
First Line	:	1514 N ZARAGOZA RD
Second Line	:	SUITE A-4
City	:	EL PASO
State	:	TX
Zip	:	79936-7905
Country	:	US
Telephone Number	:	915-857-8242
Fax Number	:	877-587-9452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/15/2010

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