Provider Demographics
NPI:1588946164
Name:TOMASIEWICZ, JEANNE L (MA, LPC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:TOMASIEWICZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W DUNLAP AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2846
Mailing Address - Country:US
Mailing Address - Phone:602-750-8705
Mailing Address - Fax:602-674-5601
Practice Address - Street 1:2301 W DUNLAP AVE STE 206
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2846
Practice Address - Country:US
Practice Address - Phone:602-750-8705
Practice Address - Fax:602-674-5601
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional