Provider Demographics
NPI:1326852104
Name:BUENTELLO, MIREYA AIDEE (LMSW)
Entity type:Individual
Prefix:
First Name:MIREYA
Middle Name:AIDEE
Last Name:BUENTELLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 VINE AVE STE A&B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4079
Mailing Address - Country:US
Mailing Address - Phone:956-451-1673
Mailing Address - Fax:
Practice Address - Street 1:1101 VINE AVE STE A&B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4079
Practice Address - Country:US
Practice Address - Phone:956-451-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker