Provider Demographics
NPI:1720595879
Name:MARCY MEVORACH, LCSW, LLC
Entity Type:Organization
Organization Name:MARCY MEVORACH, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEVORACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-707-2885
Mailing Address - Street 1:8687 E VIA DE VENTURA STE 308
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3349
Mailing Address - Country:US
Mailing Address - Phone:480-707-2885
Mailing Address - Fax:480-563-7703
Practice Address - Street 1:8687 E VIA DE VENTURA STE 308
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3349
Practice Address - Country:US
Practice Address - Phone:480-707-2885
Practice Address - Fax:480-563-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ403418Medicaid