Healthcare Provider Details

I. General information

NPI: 1972144335
Provider Name (Legal Business Name): CALISTA HEATH-MARTINEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 W RAY RD STE 200
CHANDLER AZ
85226-2496
US

IV. Provider business mailing address

2115 E INDIAN WELLS DR
CHANDLER AZ
85249-4866
US

V. Phone/Fax

Practice location:
  • Phone: 480-459-2557
  • Fax:
Mailing address:
  • Phone: 520-449-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-22818
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.026433
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: