Provider Demographics
NPI:1154497139
Name:ELIZABETH FARRAH MATTHEWS PLLC
Entity Type:Organization
Organization Name:ELIZABETH FARRAH MATTHEWS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FARRAH
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-331-3389
Mailing Address - Street 1:1200 N EL DORADO PLACE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715
Mailing Address - Country:US
Mailing Address - Phone:520-331-3389
Mailing Address - Fax:520-305-3279
Practice Address - Street 1:1200 N EL DORADO PLACE
Practice Address - Street 2:SUITE 800
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715
Practice Address - Country:US
Practice Address - Phone:520-331-3389
Practice Address - Fax:520-305-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW11711104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ116523Medicare PIN