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General NPI Number Information
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NPI Number | 1699590190
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Entity Type | Individual
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Provider Name | TARA ROY-PABLO LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 1515 E FLORENCE BLVD STE 101
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City | CASA GRANDE
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State | AZ
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Zip | 85122-5334
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Country | US
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Telephone | 602-935-6299
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Fax |
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Provider Business Mailing Address
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Address Line | 4568 E THISTLE LANDING DR
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City | PHOENIX
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State | AZ
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Zip | 85044-6849
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Country | US
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Telephone | 480-205-0158
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-12243
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License Number State | AZ
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