Healthcare Provider Details

I. General information

NPI: 1043727167
Provider Name (Legal Business Name): BLUEPAZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 N 16TH ST STE 120 #158
PHOENIX AZ
85020
US

IV. Provider business mailing address

7000 N 16TH ST STE 120 #158
PHOENIX AZ
85020
US

V. Phone/Fax

Practice location:
  • Phone: 602-345-1425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4742
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1275
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4742
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1275
License Number StateHI
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number1275
License Number StateHI
# 6
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number4742
License Number StateAZ

VIII. Authorized Official

Name: DR. DARA N. RAMPERSAD
Title or Position: CHIEF CONSULTANT
Credential: PH.D., LPC, NCC
Phone: 602-345-1425