Healthcare Provider Details

I. General information

NPI: 1720799554
Provider Name (Legal Business Name): STEPHENIE KAMAAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE SELLS

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 N CRAYCROFT RD STE 100
TUCSON AZ
85712-2811
US

IV. Provider business mailing address

3580 W INA RD STE 220
TUCSON AZ
85741-2276
US

V. Phone/Fax

Practice location:
  • Phone: 520-896-1400
  • Fax:
Mailing address:
  • Phone: 520-675-4002
  • Fax: 520-779-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21829
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW-19785
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: