Basic Information
| Provider Information | |||||||||
| NPI: | 1255058566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDRONIC | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 N PALO VERDE BLVD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857164616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027939440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 N PRIEST DR # 109 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852881213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8337190886 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2022 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 18534 | AZ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.