Provider Demographics
NPI:1053091694
Name:KAIRIS, DAVID SIMON
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SIMON
Last Name:KAIRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16825 N 14TH ST UNIT 74
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-7739
Mailing Address - Country:US
Mailing Address - Phone:970-946-9089
Mailing Address - Fax:
Practice Address - Street 1:10165 N 92ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4558
Practice Address - Country:US
Practice Address - Phone:480-994-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-19087104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker