Provider Demographics
NPI:1932960242
Name:PINKOWSKI, ELISE ANN
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:ANN
Last Name:PINKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N CENTRAL AVE # 610
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1935
Mailing Address - Country:US
Mailing Address - Phone:623-210-6199
Mailing Address - Fax:
Practice Address - Street 1:1001 N CENTRAL AVE # 610
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1935
Practice Address - Country:US
Practice Address - Phone:623-210-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-21830104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty