Provider Demographics
NPI:1942949474
Name:PRUETT, YESSENIA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:YESSENIA
Middle Name:MARIE
Last Name:PRUETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YESSENIA
Other - Middle Name:MARIE
Other - Last Name:VELEZ RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5537 MANUEL MORENO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3174
Mailing Address - Country:US
Mailing Address - Phone:931-980-5200
Mailing Address - Fax:
Practice Address - Street 1:11282 SGT CHARLES THOMAS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-742-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN92291041C0700X
TN12627104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical