Basic Information
| Provider Information | |||||||||
| NPI: | 1649682790 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMPERADOR | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | ROSETTE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 PLEASANT VALLEY DR | ||||||||
| Address2: | STE 210 | ||||||||
| City: | BOERNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780065683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302674575 | ||||||||
| FaxNumber: | 8302674575 | ||||||||
| Practice Location | |||||||||
| Address1: | 24623 KEMPER OAKS | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782607278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563418040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2014 | ||||||||
| LastUpdateDate: | 01/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 37383 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.