Provider Demographics
NPI:1568735132
Name:SANTAMARIA, MAYRA ELIZABETH (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:ELIZABETH
Last Name:SANTAMARIA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-1697
Mailing Address - Country:US
Mailing Address - Phone:669-599-6036
Mailing Address - Fax:
Practice Address - Street 1:1250 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-1697
Practice Address - Country:US
Practice Address - Phone:669-599-6036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA1047581041C0700X
AZLCSW-212311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health