Healthcare Provider Details

I. General information

NPI: 1912943390
Provider Name (Legal Business Name): ROSEMARIE A FACILLA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

1876 E SABIN DR BLDG A
CASA GRANDE AZ
85122-6197
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax: 520-629-4642
Mailing address:
  • Phone: 520-836-2536
  • Fax: 520-876-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801016562
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101305788
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101005788
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: