Healthcare Provider Details

I. General information

NPI: 1710040852
Provider Name (Legal Business Name): LAURA TAYLOR GREENWOOD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 N. 44TH STREET
PHOENIX AZ
85018
US

IV. Provider business mailing address

3610 N. 44TH STREET, # 120
PHOENIX AZ
85018
US

V. Phone/Fax

Practice location:
  • Phone: 602-218-6901
  • Fax: 602-218-6901
Mailing address:
  • Phone: 602-218-6901
  • Fax: 602-218-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11676
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11676
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: