Provider Demographics
NPI:1821688045
Name:EFFING, SERENA J
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:J
Last Name:EFFING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 E 5TH ST APT 1102
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2238
Mailing Address - Country:US
Mailing Address - Phone:520-912-2823
Mailing Address - Fax:
Practice Address - Street 1:4900 E 5TH ST
Practice Address - Street 2:APT 1102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2238
Practice Address - Country:US
Practice Address - Phone:520-912-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1831683358OtherADORA ALLIANCE