Healthcare Provider Details

I. General information

NPI: 1295527406
Provider Name (Legal Business Name): LESLIE ANAHI CENICEROS CERDA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17218 N 72ND DR
GLENDALE AZ
85308-8580
US

IV. Provider business mailing address

17218 N 72ND DR
GLENDALE AZ
85308-8580
US

V. Phone/Fax

Practice location:
  • Phone: 480-877-9284
  • Fax:
Mailing address:
  • Phone: 480-877-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-22189
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119395
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: