Provider Demographics
NPI:1992426407
Name:WILEY-CARRIZO, MEGAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:WILEY-CARRIZO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1001 E ROSE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1662
Mailing Address - Country:US
Mailing Address - Phone:480-296-1099
Mailing Address - Fax:
Practice Address - Street 1:1001 E ROSE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1662
Practice Address - Country:US
Practice Address - Phone:480-296-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical