Provider Demographics
NPI:1912943390
Name:FACILLA, ROSEMARIE A (MSW)
Entity Type:Individual
Prefix:MISS
First Name:ROSEMARIE
Middle Name:A
Last Name:FACILLA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 E SABIN DR BLDG A
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6197
Mailing Address - Country:US
Mailing Address - Phone:520-836-2536
Mailing Address - Fax:520-876-5794
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:520-629-4642
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801016562104100000X
MI4101305788106H00000X
MI4101005788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF16408006Medicare ID - Type Unspecified