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NPI Code Detail

MEDICARE: STACEY E TARQUINIO

MEDICARE: STACEY E TARQUINIO
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
1101YM0800XMental Health CounselorLPC - 10418AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194841502
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY E TARQUINIO
Provider Business Mailing Address
First Line : 2214 E FAWN DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-6944
Country : US
Telephone Number : 602-268-1157
Fax Number :
Provider Business Practice Location Address
First Line : 4414 N 19TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-4114
Country : US
Telephone Number : 602-285-5550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/09/2007

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Directions to “ STACEY E TARQUINIO ” Practice Location

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