Healthcare Provider Details

I. General information

NPI: 1184126542
Provider Name (Legal Business Name): JARA DEE BENDER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W UNION HILLS DR STE 350
PHOENIX AZ
85027-5187
US

IV. Provider business mailing address

240 S OLD LITCHFIELD RD UNIT 222
LITCHFIELD PARK AZ
85340-4711
US

V. Phone/Fax

Practice location:
  • Phone: 623-377-0446
  • Fax: 602-610-6064
Mailing address:
  • Phone: 623-377-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-20500
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLMSW-15475
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: