Healthcare Provider Details

I. General information

NPI: 1578943338
Provider Name (Legal Business Name): SOPHIA J GREENROCK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 04/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S MCCLINTOCK DR SUITE 105
TEMPE AZ
85282-2692
US

IV. Provider business mailing address

1400 E SOUTHERN AVE STE. 735
TEMPE AZ
85282-5691
US

V. Phone/Fax

Practice location:
  • Phone: 480-804-0326
  • Fax: 480-804-0083
Mailing address:
  • Phone: 480-804-0326
  • Fax: 480-804-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-15409
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: