Healthcare Provider Details

I. General information

NPI: 1538882824
Provider Name (Legal Business Name): BRENDA ESCAMILLA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18001 N 79TH AVE STE C50
GLENDALE AZ
85308-8394
US

IV. Provider business mailing address

11554 W EDGEMONT AVE
AVONDALE AZ
85392-5948
US

V. Phone/Fax

Practice location:
  • Phone: 602-492-1127
  • Fax:
Mailing address:
  • Phone: 623-241-2961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-19674
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: