Provider Demographics
NPI:1639245749
Name:WARE, JEAN MARIE
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:WARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:ROLLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4551 N AVENIDA DEL CAZADOR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6803
Mailing Address - Country:US
Mailing Address - Phone:520-591-8042
Mailing Address - Fax:520-282-4030
Practice Address - Street 1:5210 E PIMA ST
Practice Address - Street 2:STE 200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3678
Practice Address - Country:US
Practice Address - Phone:520-326-1336
Practice Address - Fax:520-795-3575
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 03821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical