Provider Demographics
NPI:1013131317
Name:ROOSEVELT SCHOOL DIST. 6218 S.7TH STREET
Entity Type:Organization
Organization Name:ROOSEVELT SCHOOL DIST. 6218 S.7TH STREET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:SOTO
Authorized Official - Last Name:SAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-243-4866
Mailing Address - Street 1:5533 E. FORGE
Mailing Address - Street 2:MESA
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:480-924-6313
Mailing Address - Fax:602-304-3132
Practice Address - Street 1:6218 S 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-4211
Practice Address - Country:US
Practice Address - Phone:602-243-4866
Practice Address - Fax:602-304-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
I24II1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty