Healthcare Provider Details

I. General information

NPI: 1346649779
Provider Name (Legal Business Name): SUSANA LENOX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 S MACDONALD
MESA AZ
85210-1310
US

IV. Provider business mailing address

32 S MACDONALD SUITES A & B
MESA AZ
85210-1310
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-1471
  • Fax: 480-264-0687
Mailing address:
  • Phone: 480-969-1471
  • Fax: 480-264-0687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3552
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: