MEDICARE: SUSAN M. DAUBENBIS LCSW

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
1	1041C0700X	Clinical Social Worker	LCSW2599	AZ

General Provider Information

NPI Number	:	1295920692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M. DAUBENBIS LCSW

Provider Business Mailing Address
First Line	:	2101 W PALMAIRE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7742
Country	:	US
Telephone Number	:	602-550-8101
Fax Number	:	602-995-7290

Provider Business Practice Location Address
First Line	:	2942 N 24TH ST
Second Line	:	SUITE 114
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7844
Country	:	US
Telephone Number	:	602-550-8101
Fax Number	:	602-995-7290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2007
Last Update Date	:	12/07/2007

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