MEDICARE: CATHOLIC CHARITIES ARCHDIOCESE OF SAN ANTONIO INC

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	101YP2500X	Professional Counselor	17263	TX
2	101YP2500X	Professional Counselor	17480	TX
3	101YP2500X	Professional Counselor	18632	TX
4	1041C0700X	Clinical Social Worker	36151	TX
5	106H00000X	Marriage & Family Therapist	200928	TX
6	1041C0700X	Clinical Social Worker	34298	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	86499Q	OTHER	TX	BCBS RUTKOWSKI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	84445L	OTHER	TX	BCBS KLINE
5	84444L	OTHER	TX	BCBS KRAVITZ
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	84446L	OTHER	TX	BCBS KNORR
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669506192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES ARCHDIOCESE OF SAN ANTONIO INC

Provider Business Mailing Address
First Line	:	2911 S NEW BRAUNFELS AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-5220
Country	:	US
Telephone Number	:	210-377-1133
Fax Number	:	210-377-1230

Provider Business Practice Location Address
First Line	:	2911 S NEW BRAUNFELS AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-5220
Country	:	US
Telephone Number	:	210-377-1133
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR
Name	:	KAREN DILIBERTI
Credential	:	LMFT-S
Telephone Number	:	210-377-1133

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	03/24/2025

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