MEDICARE: CHELSEA STANTON MSW

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	1041C0700X	Clinical Social Worker	LCSW-15930	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCSW-15930	OTHER	AZ	STATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS

General Provider Information

NPI Number	:	1023476348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA STANTON MSW

Provider Business Mailing Address
First Line	:	3131 N COUNTRY CLUB RD
Second Line	:	STE 100
City	:	TUCSON
State	:	AZ
Zip	:	85716-1649
Country	:	US
Telephone Number	:	520-325-9498
Fax Number	:	520-325-9542

Provider Business Practice Location Address
First Line	:	3131 N COUNTRY CLUB RD
Second Line	:	STE 101
City	:	TUCSON
State	:	AZ
Zip	:	85716-1649
Country	:	US
Telephone Number	:	520-325-9498
Fax Number	:	520-325-9542

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

Provider Enumeration Date	:	02/01/2016
Last Update Date	:	11/29/2016

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