Healthcare Provider Details

I. General information

NPI: 1801740477
Provider Name (Legal Business Name): DESARIE WALWYN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST # 4880
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST # 4880
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 480-447-2086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number58123
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: