Healthcare Provider Details

I. General information

NPI: 1184107096
Provider Name (Legal Business Name): RECONNECT COUNSELING OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E WARNER RD STE 100
CHANDLER AZ
85225-1057
US

IV. Provider business mailing address

122 S NEVADA WAY
GILBERT AZ
85233-4707
US

V. Phone/Fax

Practice location:
  • Phone: 602-741-8537
  • Fax: 480-892-4640
Mailing address:
  • Phone: 480-701-8828
  • Fax: 480-892-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: REBECCA VAN WAGENEN BERMUDEZ
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 480-701-8828