Provider Demographics
NPI:1417429598
Name:ASARE, DORIS NAANA
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:NAANA
Last Name:ASARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 S MARKET ST APT 1077
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1334
Mailing Address - Country:US
Mailing Address - Phone:480-433-9235
Mailing Address - Fax:
Practice Address - Street 1:3134 S MARKET ST APT 1077
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1334
Practice Address - Country:US
Practice Address - Phone:480-433-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9661356103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ9661356Medicaid