Provider Demographics
NPI:1003169244
Name:PASSARELLA, MARGO LINDA HARRISON (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:LINDA HARRISON
Last Name:PASSARELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:LINDA
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2495 N DESERT LINKS DR
Mailing Address - Street 2:#17
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3722
Mailing Address - Country:US
Mailing Address - Phone:520-248-6326
Mailing Address - Fax:
Practice Address - Street 1:502 W 29TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-3353
Practice Address - Country:US
Practice Address - Phone:520-838-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036767-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical