Provider Demographics
NPI:1144420449
Name:CATHOLIC COMMUNITY SERVICES IN SOUTHERN ARIZONA
Entity Type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES IN SOUTHERN ARIZONA
Other - Org Name:CATHOLIC SOCIAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DWYRE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, DSW
Authorized Official - Phone:520-623-0344
Mailing Address - Street 1:268 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-6534
Mailing Address - Country:US
Mailing Address - Phone:520-623-0344
Mailing Address - Fax:520-770-8578
Practice Address - Street 1:268 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-6534
Practice Address - Country:US
Practice Address - Phone:520-623-0344
Practice Address - Fax:520-770-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 104100000X, 106H00000X, 106S00000X
AZBH-984251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106009Medicare PIN