Healthcare Provider Details

I. General information

NPI: 1790951002
Provider Name (Legal Business Name): MARY HELEN FIMBRES MSW MHR LCSW ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 W NORTHERN #117 NORTHERN EXECUTIVE PLAZA
GLENDALE AZ
85301
US

IV. Provider business mailing address

5400 W NORTHERN #117 NORTHERN EXECUTIVE PLAZA
GLENDALE AZ
85301
US

V. Phone/Fax

Practice location:
  • Phone: 623-937-3556
  • Fax: 623-937-3557
Mailing address:
  • Phone: 623-937-3556
  • Fax: 623-937-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW0551
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: