Provider Demographics
NPI:1609973262
Name:WEBB, MARIE THERESE (MSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:THERESE
Last Name:WEBB
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5070 N 40TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2148
Mailing Address - Country:US
Mailing Address - Phone:602-954-6700
Mailing Address - Fax:602-954-0190
Practice Address - Street 1:5070 N 40TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2148
Practice Address - Country:US
Practice Address - Phone:602-954-6700
Practice Address - Fax:602-954-0190
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW1551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
83414Medicare ID - Type Unspecified