MEDICARE: COURTNEY DENEVI BCBA, LMSW, M.ED.

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-22770	AZ
2	104100000X	Social Worker	LMSW-18370	AZ
3	103K00000X	Behavior Analyst	1-21-54491	AZ

General Provider Information

NPI Number	:	1912651894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY DENEVI BCBA, LMSW, M.ED.

Provider Business Mailing Address
First Line	:	1555 S GILBERT RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-6000
Country	:	US
Telephone Number	:	480-750-7058
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 E PALM LN STE 255
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-4604
Country	:	US
Telephone Number	:	602-918-3664
Fax Number	:

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

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	09/13/2025

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