| Self | |
|
5010 E Shea Blvd Ste D202 Scottsdale AZ 85254-4570 | |
| (602) 569-4328 | |
| (602) 569-4378 |
| Full Name | Self |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5010 E Shea Blvd Ste D202, Scottsdale, Arizona |
| Authorized Official Name and Position | Michael Raimondi (THERAPIST) |
| Authorized Official Contact | 6025694328 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Self 5010 E Shea Blvd Ste D202 Scottsdale AZ 85254-4570 Ph: (602) 569-4328 | Self 5010 E Shea Blvd Ste D202 Scottsdale AZ 85254-4570 Ph: (602) 569-4328 |
| NPI Number | 1912372822 |
|---|---|
| Provider Enumeration Date | 12/02/2015 |
| Last Update Date | 12/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912372822 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LPC 14499 (Arizona) | Primary |
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