Healthcare Provider Details

I. General information

NPI: 1942471032
Provider Name (Legal Business Name): MICHELE R CHINICHIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 N 1ST ST
PHOENIX AZ
85004-1604
US

IV. Provider business mailing address

793 N ALMA SCHOOL RD STE D6
CHANDLER AZ
85224-3611
US

V. Phone/Fax

Practice location:
  • Phone: 602-302-7815
  • Fax: 602-258-6140
Mailing address:
  • Phone: 480-409-2915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-11578
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: