Healthcare Provider Details

I. General information

NPI: 1235445321
Provider Name (Legal Business Name): CORRIN ANN MAGRO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355TH MEDICAL GROUP/SGHC 4175 S. ALAMO AVE
DAVIS MONTHAN AZ
85707-4405
US

IV. Provider business mailing address

355TH MEDICAL GROUP/SGHC 4175 S. ALAMO AVE
DAVIS MONTHAN AZ
85707-4405
US

V. Phone/Fax

Practice location:
  • Phone: 520-228-2614
  • Fax:
Mailing address:
  • Phone: 907-580-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSWS1262
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1262
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: