Healthcare Provider Details

I. General information

NPI: 1154513158
Provider Name (Legal Business Name): ALLISON MARIE CUOCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON MARIE LARSEN

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34225 N 27TH DR STE 130
PHOENIX AZ
85085-6089
US

IV. Provider business mailing address

34225 N 27TH DR STE 130
PHOENIX AZ
85085-6089
US

V. Phone/Fax

Practice location:
  • Phone: 602-347-2653
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: