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NPI Code Detail

MEDICARE: REITA JENAE JUAREZ LMSW

MEDICARE: REITA JENAE JUAREZ LMSW
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
11041C0700XClinical Social WorkerLCSW-17605AZ

General Provider Information

NPI Number : 1568968287
Entity Type Code : Individual
Provider Name (Legal Business Name) : REITA JENAE JUAREZ LMSW
Provider Business Mailing Address
First Line : 1946 E INVERNESS CIR
Second Line :
City : MESA
State : AZ
Zip : 85204-8018
Country : US
Telephone Number : 801-310-7591
Fax Number :
Provider Business Practice Location Address
First Line : 1910 S STAPLEY DR STE 221
Second Line :
City : MESA
State : AZ
Zip : 85204-6680
Country : US
Telephone Number : 480-681-7772
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2018
Last Update Date : 02/03/2023

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