Healthcare Provider Details

I. General information

NPI: 1659980894
Provider Name (Legal Business Name): CYNTHIA HAUSER LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E SHEA BLVD STE 200
PHOENIX AZ
85028-6058
US

IV. Provider business mailing address

901 E BERRIDGE LN
PHOENIX AZ
85014-1909
US

V. Phone/Fax

Practice location:
  • Phone: 480-313-0020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA HAUSER
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 480-313-0020