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General NPI Number Information
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NPI Number | 1548772684
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Entity Type | Organization
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Legal Business Name | AZ THERAPY LLC
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 2633 E INDIAN SCHOOL RD STE 250
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City | PHOENIX
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State | AZ
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Zip | 85016-0703
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Country | US
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Telephone | 424-465-3058
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 E ELM ST
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City | PHOENIX
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State | AZ
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Zip | 85016-4808
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Country | US
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Telephone | 424-465-3058
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | MS. SOFIA HASSID
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Credential | LCSW
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Telephone | 424-465-3058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16812
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License Number State | AZ
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