MEDICARE: MARIPOSA WELLNESS CENTER, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1326686965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIPOSA WELLNESS CENTER, PLLC

Provider Business Mailing Address
First Line	:	4309 N 22ND ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-4167
Country	:	US
Telephone Number	:	956-960-0164
Fax Number	:

Provider Business Practice Location Address
First Line	:	4309 N 22ND ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-4167
Country	:	US
Telephone Number	:	956-960-0164
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/LEAD CLINICIAN
Name	:	MS. LUCIA ANNA LEO
Credential	:	LCSW-S, BCD
Telephone Number	:	956-960-0164

Provider Enumeration Date	:	12/13/2019
Last Update Date	:	12/13/2019

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