Provider Demographics
NPI:1811213515
Name:FIDALGO, MARIA GORETH (LCSW)
Entity type:Individual
Prefix:
First Name:MARIA GORETH
Middle Name:
Last Name:FIDALGO
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 1:6216 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5433
Mailing Address - Country:US
Mailing Address - Phone:480-588-8006
Mailing Address - Fax:617-249-0962
Practice Address - Street 1:6216 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5433
Practice Address - Country:US
Practice Address - Phone:480-588-8006
Practice Address - Fax:617-249-0962
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-124621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical