Healthcare Provider Details

I. General information

NPI: 1932813417
Provider Name (Legal Business Name): ANTOINETTE SANTA CRUZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANTOINETTE VERDIN LCSW

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 N 2ND ST STE 601
PHOENIX AZ
85012-2395
US

IV. Provider business mailing address

3101 N CENTRAL AVE STE 550
PHOENIX AZ
85012-2635
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-7373
  • Fax: 602-230-5105
Mailing address:
  • Phone: 602-230-7373
  • Fax: 602-682-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-22616
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: