Provider Demographics
NPI:1033397823
Name:GREY, JOAN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:GREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 W. SEED FARM RD.
Mailing Address - Street 2:NEW BEGINNINGS BUILDING
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85247
Mailing Address - Country:US
Mailing Address - Phone:602-528-7136
Mailing Address - Fax:602-528-1374
Practice Address - Street 1:483 W. SEED FARM RD
Practice Address - Street 2:NEW BEGINNINGS BUILDING
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85247
Practice Address - Country:US
Practice Address - Phone:602-528-7136
Practice Address - Fax:602-528-1374
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-02021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ346214Medicaid