Provider Demographics
NPI:1588048243
Name:GUERRERO, JUAN RAUL (LCSW)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:RAUL
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 CAMINO REAL VIEJO
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-9486
Mailing Address - Country:US
Mailing Address - Phone:956-299-2265
Mailing Address - Fax:956-338-5629
Practice Address - Street 1:2411 CAMINO REAL VIEJO
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-9486
Practice Address - Country:US
Practice Address - Phone:956-299-2265
Practice Address - Fax:956-338-5629
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX557931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138708613Medicaid
TX00R945OtherMEDICARE
TX352174202Medicaid