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NPI Code Detail

MEDICARE: LISA MARIE GASTALDI LIAC

MEDICARE: LISA MARIE GASTALDI LIAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor16482-130WI
2101YA0400XAddiction (Substance Use Disorder) Counselor155344AZ

General Provider Information

NPI Number : 1104187053
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE GASTALDI LIAC
Provider Business Mailing Address
First Line : 3003 N CENTRAL AVE STE 400
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2929
Country : US
Telephone Number : 602-685-6000
Fax Number : 26-302-7925
Provider Business Practice Location Address
First Line : 4909 E MCDOWELL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-4227
Country : US
Telephone Number : 602-685-6000
Fax Number : 602-275-1355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2012
Last Update Date : 12/09/2024

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Directions to “ LISA MARIE GASTALDI LIAC” Practice Location

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