Provider Demographics
NPI:1073397469
Name:PIETSCH, SABRINA (LMSW)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:PIETSCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 N 31ST AVE STE C218
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9620
Mailing Address - Country:US
Mailing Address - Phone:602-314-6312
Mailing Address - Fax:
Practice Address - Street 1:10000 N 31ST AVE STE C218
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9620
Practice Address - Country:US
Practice Address - Phone:602-314-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20829104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty