Provider Demographics
NPI:1962113357
Name:DEDICATED DRAGONFLY THERAPY, LLC
Entity type:Organization
Organization Name:DEDICATED DRAGONFLY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-677-9497
Mailing Address - Street 1:11820 N 43RD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-3001
Mailing Address - Country:US
Mailing Address - Phone:602-677-9497
Mailing Address - Fax:
Practice Address - Street 1:10000 N 31ST AVE STE C100-152
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1397
Practice Address - Country:US
Practice Address - Phone:602-833-8262
Practice Address - Fax:602-883-7847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health