Healthcare Provider Details

I. General information

NPI: 1376282632
Provider Name (Legal Business Name): NORA ANDREA CARRIZOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 E MAIN ST STE 104
MESA AZ
85203-8950
US

IV. Provider business mailing address

1345 E MAIN ST STE 104
MESA AZ
85203-8950
US

V. Phone/Fax

Practice location:
  • Phone: 480-300-4741
  • Fax:
Mailing address:
  • Phone: 480-300-4741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLAMFT-11001
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: