Provider Demographics
NPI:1548772684
Name:AZ THERAPY LLC
Entity Type:Organization
Organization Name:AZ THERAPY LLC
Other - Org Name:ROAD TO THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSID
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:424-465-3058
Mailing Address - Street 1:2401 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4808
Mailing Address - Country:US
Mailing Address - Phone:424-465-3058
Mailing Address - Fax:
Practice Address - Street 1:2633 E INDIAN SCHOOL RD STE 250
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-0703
Practice Address - Country:US
Practice Address - Phone:424-465-3058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ168121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ429932Medicaid