Healthcare Provider Details

I. General information

NPI: 1780621862
Provider Name (Legal Business Name): GEORGINA L FISCUS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEORGINA L. TRUEBLOOD

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S. OCOTILLO AVE.
BENSON AZ
85602-6405
US

IV. Provider business mailing address

611 W. UNION ST.
BENSON AZ
85602
US

V. Phone/Fax

Practice location:
  • Phone: 800-586-7080
  • Fax: 520-586-3161
Mailing address:
  • Phone: 520-586-0800
  • Fax: 520-586-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW10635
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-10635
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: