Provider Demographics
NPI:1043490287
Name:LONETTI, MARCIA
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:
Last Name:LONETTI
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 1:40404 N GAVILAN PEAK PKWY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2754
Mailing Address - Country:US
Mailing Address - Phone:623-445-8618
Mailing Address - Fax:623-445-8680
Practice Address - Street 1:40404 N GAVILAN PEAK PKWY
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-2754
Practice Address - Country:US
Practice Address - Phone:623-445-8618
Practice Address - Fax:623-445-8680
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool