Provider Demographics
NPI:1073771275
Name:CORTESE, MARCIA W (MA,LMFT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:W
Last Name:CORTESE
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E BETHANY HOME RD
Mailing Address - Street 2:SUITE C296
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1263
Mailing Address - Country:US
Mailing Address - Phone:602-604-8448
Mailing Address - Fax:
Practice Address - Street 1:301 E BETHANY HOME RD
Practice Address - Street 2:SUITE C296
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1263
Practice Address - Country:US
Practice Address - Phone:602-604-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT0109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist