MEDICARE: EARLENE J DEAR MSW, 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	101YM0800X	Mental Health Counselor	LCSW-0195	AZ

General Provider Information

NPI Number	:	1578647749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARLENE J DEAR MSW, LCSW

Provider Business Mailing Address
First Line	:	7400 N ORACLE RD STE 100J
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-6329
Country	:	US
Telephone Number	:	520-575-1058
Fax Number	:	520-742-1427

Provider Business Practice Location Address
First Line	:	4765 N PASEO DE LOS RANCHEROS
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-9732
Country	:	US
Telephone Number	:	520-575-1058
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/13/2020

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