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19235 N Cave Creek Rd Ste 102 Phoenix AZ 85024-3025 | |
| (602) 935-1464 | |
| (808) 376-1054 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 19235 N Cave Creek Rd Ste 102, Phoenix, Arizona |
| Authorized Official Name and Position | Rowell V Laino (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6029351464 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
12232 Sea Voyage Ave Las Vegas NV 89138-4606 Ph: (602) 935-1464 | 19235 N Cave Creek Rd Ste 102 Phoenix AZ 85024-3025 Ph: (602) 935-1464 |
| NPI Number | 1750127007 |
|---|---|
| Provider Enumeration Date | 07/06/2024 |
| Last Update Date | 08/28/2024 |
| Certification Date | 08/28/2024 |
| Medicare PECOS PAC ID | 6709317613 |
|---|---|
| Medicare Enrollment ID | O20241002003943 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750127007 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Rowena Santos Laino |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1578840070 PECOS PAC ID: 3173938198 Enrollment ID: I20241014002840 |
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