MEDICARE: RANDI RENEE LUEVANO 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	1041C0700X	Clinical Social Worker	LCSW-18349	AZ
2	1041S0200X	School Social Worker	LMSW-14112	AZ

General Provider Information

NPI Number	:	1295159069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI RENEE LUEVANO LCSW

Provider Business Mailing Address
First Line	:	2036 N GILBERT RD # 2-511
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-2139
Country	:	US
Telephone Number	:	480-318-4021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 E SOUTHERN AVE STE 3A
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5247
Country	:	US
Telephone Number	:	480-359-4905
Fax Number	:

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

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	02/09/2026

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