Provider Demographics
NPI:1528490828
Name:MAESTAS, VICKI PICKLE (LBSW)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:PICKLE
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 DELTA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-5406
Mailing Address - Country:US
Mailing Address - Phone:915-775-2710
Mailing Address - Fax:
Practice Address - Street 1:6314 DELTA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-5406
Practice Address - Country:US
Practice Address - Phone:915-775-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55943171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator