Healthcare Provider Details

I. General information

NPI: 1316543911
Provider Name (Legal Business Name): TONI MARIA SEWELL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI MARIA PAVESE

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N 16TH ST STE 102
PHOENIX AZ
85020-5266
US

IV. Provider business mailing address

8633 W MARCONI AVE
PEORIA AZ
85382-4721
US

V. Phone/Fax

Practice location:
  • Phone: 602-301-0927
  • Fax:
Mailing address:
  • Phone: 602-301-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-15493
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: