Provider Demographics
NPI:1841959731
Name:ONTIVEROS, TANIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:TANIA
Middle Name:
Last Name:ONTIVEROS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14948
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-4948
Mailing Address - Country:US
Mailing Address - Phone:480-793-1059
Mailing Address - Fax:
Practice Address - Street 1:1300 N 12TH ST STE 550
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2820
Practice Address - Country:US
Practice Address - Phone:623-213-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-180101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical