Provider Demographics
NPI:1790669679
Name:ESTRADA, EUGENE ERNESTO (LCSW)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:ERNESTO
Last Name:ESTRADA
Suffix:
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:PO BOX 79534
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-0534
Mailing Address - Country:US
Mailing Address - Phone:469-294-3639
Mailing Address - Fax:
Practice Address - Street 1:101 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1558
Practice Address - Country:US
Practice Address - Phone:737-298-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1063151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical