Provider Demographics
NPI:1760290456
Name:LARES, GLORIA MARIE
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:MARIE
Last Name:LARES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:MARIE
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2409 TIERRA MURCIA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2386
Mailing Address - Country:US
Mailing Address - Phone:915-205-1434
Mailing Address - Fax:
Practice Address - Street 1:5625 WOODROW BEAN STE 106
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4143
Practice Address - Country:US
Practice Address - Phone:915-205-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1109331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical