Healthcare Provider Details

I. General information

NPI: 1790615854
Provider Name (Legal Business Name): OLIVIA MICHELLE RORAGEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N 33RD AVE
PHOENIX AZ
85017-5202
US

IV. Provider business mailing address

3001 N 33RD AVE
PHOENIX AZ
85017-5202
US

V. Phone/Fax

Practice location:
  • Phone: 602-353-0703
  • Fax: 602-353-0715
Mailing address:
  • Phone: 602-353-0703
  • Fax: 602-353-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23810
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: