Healthcare Provider Details

I. General information

NPI: 1306567318
Provider Name (Legal Business Name): LAUREN BASILE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 E THOMAS RD # 100
PHOENIX AZ
85016-8220
US

IV. Provider business mailing address

6816 E WETHERSFIELD RD
SCOTTSDALE AZ
85254-5360
US

V. Phone/Fax

Practice location:
  • Phone: 602-957-2507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: