MEDICARE: MRS. SARA MCNELY LCSE

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-22968	AZ

General Provider Information

NPI Number	:	1790225043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA MCNELY LCSE

Provider Business Mailing Address
First Line	:	6602 W TETHER TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-1054
Country	:	US
Telephone Number	:	818-454-3570
Fax Number	:

Provider Business Practice Location Address
First Line	:	4657 S LAKESHORE DR STE 1
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7170
Country	:	US
Telephone Number	:	480-718-1261
Fax Number	:

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

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	05/05/2025

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