Provider Demographics
NPI:1184717449
Name:BUENSUCESO, MONICA ARLETT (MA)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ARLETT
Last Name:BUENSUCESO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 S 233RD AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-4058
Mailing Address - Country:US
Mailing Address - Phone:623-386-1625
Mailing Address - Fax:
Practice Address - Street 1:9261 W VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-2941
Practice Address - Country:US
Practice Address - Phone:623-907-5270
Practice Address - Fax:623-907-5271
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3639584101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ124383OtherAHCCCS PROVIDER ID