MEDICARE: TIFFANY JUAREZ 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	1041C0700X	Clinical Social Worker	55058	TX

General Provider Information

NPI Number	:	1407262264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY JUAREZ LCSW

Provider Business Mailing Address
First Line	:	909 NE LOOP 410 STE 634
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1309
Country	:	US
Telephone Number	:	210-325-5809
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 NE LOOP 410 STE 634
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1309
Country	:	US
Telephone Number	:	210-325-5809
Fax Number	:

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

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	09/01/2023

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Directions to “ TIFFANY JUAREZ LCSW” Practice Location

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