Healthcare Provider Details

I. General information

NPI: 1851592661
Provider Name (Legal Business Name): JENNIFER REBECCA SERLIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 N HAYDEN RD
SCOTTSDALE AZ
85258-2458
US

IV. Provider business mailing address

7729 N VIA DEL SENDERO
SCOTTSDALE AZ
85258-3333
US

V. Phone/Fax

Practice location:
  • Phone: 480-467-0232
  • Fax: 480-467-0243
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3787
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: