Provider Demographics
NPI:1780296087
Name:FINOCCHIO, ELYSE (LAC)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:FINOCCHIO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 W OLIVE AVE # 437
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4205
Mailing Address - Country:US
Mailing Address - Phone:602-502-0698
Mailing Address - Fax:
Practice Address - Street 1:12202 N 101ST AVE RM A
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3543
Practice Address - Country:US
Practice Address - Phone:682-502-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional