Healthcare Provider Details

I. General information

NPI: 1235785163
Provider Name (Legal Business Name): BETH J DOLOBOWSKY L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CENTRAL AVE STE 204
PHOENIX AZ
85004-1844
US

IV. Provider business mailing address

PO BOX 5177
PHOENIX AZ
85010-5177
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-6550
  • Fax: 602-344-6551
Mailing address:
  • Phone: 602-344-5651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-16412
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: