MEDICARE: SYLVIA K NEAL LCSW PLLC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center	10922	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TIN	OTHER
2	LCSW 10922	OTHER	AZ	LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033253307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYLVIA K NEAL LCSW PLLC

Provider Business Mailing Address
First Line	:	7360 N LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2305
Country	:	US
Telephone Number	:	520-722-3777
Fax Number	:	520-296-6224

Provider Business Practice Location Address
First Line	:	7360 N LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2305
Country	:	US
Telephone Number	:	520-219-1992
Fax Number	:	678-244-7858

Authorized Official
Title or Position	:	OWNER
Name	:	SYLVIA K NEAL
Credential	:	LCSW
Telephone Number	:	520-219-1992

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/21/2022

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