Provider Demographics
NPI:1386641124
Name:MAGDALENO, NORMA (LCSW)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:MAGDALENO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 N 1ST AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2560
Mailing Address - Country:US
Mailing Address - Phone:520-326-8953
Mailing Address - Fax:
Practice Address - Street 1:3045 N 1ST AVE
Practice Address - Street 2:STE A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2560
Practice Address - Country:US
Practice Address - Phone:520-326-8953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW115771041C0700X
NMI-058791041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39375072Medicaid