Provider Demographics
NPI:1144893694
Name:REVERON, IMELDA RAMIREZ (MA, CLINICIAN)
Entity type:Individual
Prefix:
First Name:IMELDA
Middle Name:RAMIREZ
Last Name:REVERON
Suffix:
Gender:F
Credentials:MA, CLINICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21916 PARK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2749
Mailing Address - Country:US
Mailing Address - Phone:210-844-9985
Mailing Address - Fax:210-600-3849
Practice Address - Street 1:4335 W PIEDRAS DR STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1215
Practice Address - Country:US
Practice Address - Phone:210-600-4117
Practice Address - Fax:210-600-3849
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty