Healthcare Provider Details

I. General information

NPI: 1538995568
Provider Name (Legal Business Name): WENDY RICHARD MA, MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W TALAVI BLVD STE 180
GLENDALE AZ
85306-1888
US

IV. Provider business mailing address

1636 W INDIANOLA AVE
PHOENIX AZ
85015-5553
US

V. Phone/Fax

Practice location:
  • Phone: 623-486-8202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22445
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: