Healthcare Provider Details

I. General information

NPI: 1942585195
Provider Name (Legal Business Name): SOFIA ANNA CROWE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOFIA ANNA TOLSTOSHEV

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALLE PORTAL STE 700
SIERRA VISTA AZ
85635
US

IV. Provider business mailing address

155 CALLE PORTAL STE 100
SIERRA VISTA AZ
85635-2900
US

V. Phone/Fax

Practice location:
  • Phone: 520-459-0203
  • Fax: 520-515-8663
Mailing address:
  • Phone: 520-515-8673
  • Fax: 520-515-8663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13351
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: