Provider Demographics
NPI:1780883488
Name:TAMAGNI, DORI S (LCSW-13910)
Entity type:Individual
Prefix:MS
First Name:DORI
Middle Name:S
Last Name:TAMAGNI
Suffix:
Gender:F
Credentials:LCSW-13910
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39213 S WILD HARDT WAY
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-8396
Mailing Address - Country:US
Mailing Address - Phone:520-400-9444
Mailing Address - Fax:520-879-6099
Practice Address - Street 1:39213 S WILD HARDT WAY
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-8396
Practice Address - Country:US
Practice Address - Phone:520-400-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ139101041C0700X
AZ10728101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ218075Medicaid