Healthcare Provider Details

I. General information

NPI: 1669023644
Provider Name (Legal Business Name): MAURA A SOSNICKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 W BELL RD STE B05
GLENDALE AZ
85308-8544
US

IV. Provider business mailing address

7055 W BELL RD STE B05
GLENDALE AZ
85308-8544
US

V. Phone/Fax

Practice location:
  • Phone: 480-757-8090
  • Fax: 904-615-6588
Mailing address:
  • Phone: 480-757-8090
  • Fax: 904-615-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-002094
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: