Provider Demographics
NPI:1134618242
Name:ELIAS, MARGARITA N (LCSW)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:N
Last Name:ELIAS
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 1:825 N GRAND AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2385
Mailing Address - Country:US
Mailing Address - Phone:520-761-2133
Mailing Address - Fax:520-761-2157
Practice Address - Street 1:1852 N MASTICK WAY
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-1063
Practice Address - Country:US
Practice Address - Phone:520-281-1550
Practice Address - Fax:520-281-4487
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-170091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-17009OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS
AZ385441Medicaid