Healthcare Provider Details

I. General information

NPI: 1225457559
Provider Name (Legal Business Name): CARINA STAFFORD MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E BROADWAY RD APT 2062
TEMPE AZ
85282-1663
US

IV. Provider business mailing address

1500 E BROADWAY RD APT 2062
TEMPE AZ
85282-1663
US

V. Phone/Fax

Practice location:
  • Phone: 480-309-3497
  • Fax:
Mailing address:
  • Phone: 480-309-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number11228
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: