Healthcare Provider Details

I. General information

NPI: 1063341618
Provider Name (Legal Business Name): SASHA NAOMI JAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2187 N VICKEY ST
FLAGSTAFF AZ
86004-6121
US

IV. Provider business mailing address

70 E ORCHID DR
WILLIAMS AZ
86046-8323
US

V. Phone/Fax

Practice location:
  • Phone: 928-527-1899
  • Fax:
Mailing address:
  • Phone: 928-527-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23809
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: