Provider Demographics
NPI:1992739502
Name:PACETTI, EDWARD LOUIS JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LOUIS
Last Name:PACETTI
Suffix:JR
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 1:214 RENNER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2727
Mailing Address - Country:US
Mailing Address - Phone:210-683-3810
Mailing Address - Fax:
Practice Address - Street 1:4203 WOODCOCK DR
Practice Address - Street 2:SUITE 265
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1320
Practice Address - Country:US
Practice Address - Phone:210-683-3810
Practice Address - Fax:210-695-7702
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TX237631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149062502Medicaid
TXTXB103260Medicare PIN