Staci Detwiler, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-22553 Issued in AZ

Practice address

4646 E Greenway Rd Ste 100
Phoenix, AZ 85032-4805

Phone

(480) 674-9220

Fax

(480) 674-9231

NPI assigned

Jul 20, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

FKL Enterprises LLCGroup PAC ID 2961872205, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• FKL Enterprises, LLC

  dba reVIBE Mental Health

  • Marriage & Family Therapist
  • Scottsdale, AZ
  • NPI 1346982782
  Medicare reassignment Care Compare group NPD
• FKL Enterprises, LLC

  dba reVIBE Mental Health

  • Marriage & Family Therapist
  • Phoenix, AZ
  • NPI 1316796790
  NPD
• Evolvedmd, Inc.

  dba evolvedMD

  • Community/Behavioral Health Agency
  • Scottsdale, AZ
  • NPI 1821613704
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1073248357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3334 E GELDING DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850325352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 E GREENWAY RD STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850324805",
            "telephone_number": "480-674-9220",
            "fax_number": "480-674-9231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETWILER",
        "first_name": "STACI",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-20",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-22553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniella Darlene Detjens
• Corey L Detlefs, MD
• Erin C Detorie, CNP
• Detox Centers LLC
• Christa Dettmer, SLP
• Tyler Scott Detwiler, CRNA
• Laureen Deublein
• Daniel Joseph Deusterman, F.N.P.
• Patricia Deutsch, BS HEALTH COACH
• Sharon Deutsch

• Clinical Social Worker in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.