Provider Demographics
NPI:1730316746
Name:NOONAN, DENNIS W (LCSW)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:W
Last Name:NOONAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 E BROADWAY BLVD
Mailing Address - Street 2:#100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5398
Mailing Address - Country:US
Mailing Address - Phone:520-791-2711
Mailing Address - Fax:520-791-2202
Practice Address - Street 1:1475 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7236
Practice Address - Country:US
Practice Address - Phone:520-624-5806
Practice Address - Fax:520-624-5817
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-08511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ750986Medicaid