MEDICARE: MR. JAMAL MAYHEW 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	LCSW - 11300	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881739340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMAL MAYHEW LCSW

Provider Business Mailing Address
First Line	:	3104 E CAMELBACK RD UNIT 7155
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4502
Country	:	US
Telephone Number	:	480-382-0114
Fax Number	:

Provider Business Practice Location Address
First Line	:	3921 W BASELINE ROAD
Second Line	:
City	:	LAVEEN VILLAGE
State	:	AZ
Zip	:	85339
Country	:	US
Telephone Number	:	480-382-0114
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	04/06/2022

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