Healthcare Provider Details

I. General information

NPI: 1659736098
Provider Name (Legal Business Name): SHAWNTAE STEVENSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S STAPLEY DR STE 120
MESA AZ
85204-6676
US

IV. Provider business mailing address

1910 S STAPLEY DR STE 120
MESA AZ
85204-6676
US

V. Phone/Fax

Practice location:
  • Phone: 520-447-1606
  • Fax:
Mailing address:
  • Phone: 520-447-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number095374-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW-23328
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: