Provider Demographics
NPI:1699463570
Name:DEWESE, CLARISSA BROOKE
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:BROOKE
Last Name:DEWESE
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 1:4480 W PEORIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-2039
Mailing Address - Country:US
Mailing Address - Phone:602-400-0231
Mailing Address - Fax:
Practice Address - Street 1:4480 W PEORIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-2039
Practice Address - Country:US
Practice Address - Phone:702-743-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician