Provider Demographics
NPI:1801913017
Name:VALENZUELA, LISA ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:VALENZUELA
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 1:4635 S PASEO RIO BRAVO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-1188
Mailing Address - Country:US
Mailing Address - Phone:520-881-7188
Mailing Address - Fax:520-232-8225
Practice Address - Street 1:4635 S PASEO RIO BRAVO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1188
Practice Address - Country:US
Practice Address - Phone:520-881-7118
Practice Address - Fax:520-232-8225
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSW1414M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker