MEDICARE: ATIQ MIRRIAM SHOMAR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LCSW-13586	AZ

General Provider Information

NPI Number	:	1013202837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATIQ MIRRIAM SHOMAR LCSW

Provider Business Mailing Address
First Line	:	10501 E SEVEN GENERATIONS WAY STE 121
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5828
Country	:	US
Telephone Number	:	520-833-4290
Fax Number	:	888-972-9484

Provider Business Practice Location Address
First Line	:	10501 E SEVEN GENERATIONS WAY STE 121
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5828
Country	:	US
Telephone Number	:	520-833-4290
Fax Number	:	888-972-9484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	05/23/2024

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