Provider Demographics
NPI:1477655934
Name:PACHECO, ZONA T (LCSW)
Entity type:Individual
Prefix:
First Name:ZONA
Middle Name:T
Last Name:PACHECO
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 1:2052 N 80TH PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-2155
Mailing Address - Country:US
Mailing Address - Phone:480-396-5405
Mailing Address - Fax:480-807-8973
Practice Address - Street 1:3303 E BASELINE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2738
Practice Address - Country:US
Practice Address - Phone:480-539-7022
Practice Address - Fax:480-545-6773
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSW-027411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR32412Medicare UPIN