MEDICARE: MS. BRIDGET NAUGHTON LISAC

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	1538	AZ

General Provider Information

NPI Number	:	1801986344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIDGET NAUGHTON LISAC

Provider Business Mailing Address
First Line	:	1046 E BUCKEYE RD
Second Line	:	CHICANOS POR LA CAUSA, INC
City	:	PHOENIX
State	:	AZ
Zip	:	85034-4041
Country	:	US
Telephone Number	:	602-254-4827
Fax Number	:	602-257-6796

Provider Business Practice Location Address
First Line	:	3639 W LINCOLN ST
Second Line	:	CORAZON I
City	:	PHOENIX
State	:	AZ
Zip	:	85009-5516
Country	:	US
Telephone Number	:	602-233-9747
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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