Healthcare Provider Details

I. General information

NPI: 1851583850
Provider Name (Legal Business Name): MARCY MEVORACH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 05/28/2022
Certification Date: 05/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8687 E VIA DE VENTURA STE 308
SCOTTSDALE AZ
85258-3349
US

IV. Provider business mailing address

8687 E VIA DE VENTURA STE 308
SCOTTSDALE AZ
85258-3349
US

V. Phone/Fax

Practice location:
  • Phone: 480-707-2885
  • Fax:
Mailing address:
  • Phone: 480-707-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13047
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7796
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069203-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2217623
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12488
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: