Provider Demographics
NPI:1578647749
Name:DEAR, EARLENE J (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:EARLENE
Middle Name:J
Last Name:DEAR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 N ORACLE RD STE 100J
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6329
Mailing Address - Country:US
Mailing Address - Phone:520-575-1058
Mailing Address - Fax:520-742-1427
Practice Address - Street 1:4765 N PASEO DE LOS RANCHEROS
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9732
Practice Address - Country:US
Practice Address - Phone:520-575-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-0195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR10554Medicare UPIN