Provider Demographics
NPI:1295926798
Name:MATTHEWS, ELIZABETH FARRAH (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FARRAH
Last Name:MATTHEWS
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 1:1200 N EL DORADO PL STE 800
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4646
Mailing Address - Country:US
Mailing Address - Phone:520-331-3389
Mailing Address - Fax:520-305-3279
Practice Address - Street 1:1200 N EL DORADO PL STE 800
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4646
Practice Address - Country:US
Practice Address - Phone:520-331-3389
Practice Address - Fax:520-305-3279
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-117111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ116524Medicare PIN