Healthcare Provider Details

I. General information

NPI: 1386141455
Provider Name (Legal Business Name): CORA LYNN JANOE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/13/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11518 E APACHE TRL STE 129
APACHE JUNCTION AZ
85120-3572
US

IV. Provider business mailing address

11518 E APACHE TRL STE 129
APACHE JUNCTION AZ
85120-3572
US

V. Phone/Fax

Practice location:
  • Phone: 480-317-2214
  • Fax:
Mailing address:
  • Phone: 480-317-2214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW-22545
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: