Provider Demographics
NPI:1942951843
Name:CARRASCO, MAYTE ALEJANDRA (LMSW)
Entity Type:Individual
Prefix:
First Name:MAYTE
Middle Name:ALEJANDRA
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51081
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-0055
Mailing Address - Country:US
Mailing Address - Phone:480-542-4668
Mailing Address - Fax:877-559-2816
Practice Address - Street 1:5700 W OLIVE AVE STE 103
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3147
Practice Address - Country:US
Practice Address - Phone:602-492-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical