Provider Demographics
NPI:1962674325
Name:BIZAHALONI, ELAINE (LMSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:BIZAHALONI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:VALENCIA
Other - Middle Name:
Other - Last Name:BIZAHALONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO DRAWER PH
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503
Mailing Address - Country:US
Mailing Address - Phone:928-725-7001
Mailing Address - Fax:928-725-7705
Practice Address - Street 1:NR 4 TWO MILES EAST OF PINON
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-725-9660
Practice Address - Fax:928-725-9654
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-06047104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker