Provider Demographics
NPI:1215243415
Name:NEW PATHWAYS PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:NEW PATHWAYS PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KARLAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMANCHE-RAFINDADI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-459-3600
Mailing Address - Street 1:1858 PASEO SAN LUIS STE D
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5825
Mailing Address - Country:US
Mailing Address - Phone:520-458-3600
Mailing Address - Fax:520-458-3605
Practice Address - Street 1:1858 PASEO SAN LUIS STE D
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5825
Practice Address - Country:US
Practice Address - Phone:520-458-3600
Practice Address - Fax:520-458-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1194855981OtherTYPE 1