Healthcare Provider Details

I. General information

NPI: 1407201288
Provider Name (Legal Business Name): LAURIE TIMARAC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 E OAK ST
PHOENIX AZ
85008-2410
US

IV. Provider business mailing address

202 E EARLL DR SUITE 200
PHOENIX AZ
85012-2634
US

V. Phone/Fax

Practice location:
  • Phone: 602-957-2220
  • Fax: 602-956-3486
Mailing address:
  • Phone: 602-957-2220
  • Fax: 602-956-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-1325
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: