Provider Demographics
NPI:1235350877
Name:TITLEY, JENNIFER ELIZABETH (MSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:TITLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:TITLEY-RUBIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:525 E LAWTON ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 E TENTH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-225-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-10211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ878944Medicaid