Provider Demographics
NPI:1962758003
Name:BARONE, AUDREY (CERTIFIED MANAGER)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:BARONE
Suffix:
Gender:F
Credentials:CERTIFIED MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11240 E SHADY LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9776
Mailing Address - Country:US
Mailing Address - Phone:520-749-4846
Mailing Address - Fax:520-749-1319
Practice Address - Street 1:11240 E SHADY LN
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9776
Practice Address - Country:US
Practice Address - Phone:520-749-4846
Practice Address - Fax:520-749-1319
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL7365H101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty