Healthcare Provider Details

I. General information

NPI: 1487165031
Provider Name (Legal Business Name): SOFIA ELVIRA PHILIPS MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2017
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18275 N 59TH AVE STE K-164
GLENDALE AZ
85308-1260
US

IV. Provider business mailing address

18275 N 59TH AVE STE K-164
GLENDALE AZ
85308-1260
US

V. Phone/Fax

Practice location:
  • Phone: 602-499-5329
  • Fax:
Mailing address:
  • Phone: 602-499-5329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMSW-13611
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-13611
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: