Provider Demographics
NPI:1790358943
Name:VALLEY MOBILE PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:VALLEY MOBILE PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EWELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-658-9640
Mailing Address - Street 1:1509 E CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4815
Mailing Address - Country:US
Mailing Address - Phone:480-658-9640
Mailing Address - Fax:
Practice Address - Street 1:1509 E CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4815
Practice Address - Country:US
Practice Address - Phone:480-658-9640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty