Basic Information
Provider Information | |||||||||
NPI: | 1396168993 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SPEARMAN | ||||||||
FirstName: | CARLA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | RATNER | ||||||||
OtherFirstName: | CARLA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LCSW-C | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 4747 N 7TH STREET | ||||||||
Address2: | SUITE 100 | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 85014 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6022797655 | ||||||||
FaxNumber: | 6022538891 | ||||||||
Practice Location | |||||||||
Address1: | 5701 W TALAVI BLVD | ||||||||
Address2: | SUITE 180 | ||||||||
City: | GLENDALE | ||||||||
State: | AZ | ||||||||
PostalCode: | 85306 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6234868202 | ||||||||
FaxNumber: | 6234862739 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/03/2014 | ||||||||
LastUpdateDate: | 01/09/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 16874 | MD | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 16819 | AZ | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.