Provider Demographics
NPI:1851573158
Name:YANAGISAWA, MISA (LCSW)
Entity Type:Individual
Prefix:
First Name:MISA
Middle Name:
Last Name:YANAGISAWA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 W LOWER BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-6729
Mailing Address - Country:US
Mailing Address - Phone:602-876-6802
Mailing Address - Fax:
Practice Address - Street 1:3250 W LOWER BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-6729
Practice Address - Country:US
Practice Address - Phone:602-876-3813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW136231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical