Active NPI
Christine L Willis, MSW
- Clinical Social Worker
- Phoenix, AZ
National Provider Identifier
1336708833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 17675
- Practice address
- 4527 N 16TH St Ste 104
Phoenix, AZ 85016-5353 - Phone
- (602) 845-8000
- Fax
- (602) 845-8001
- NPI assigned
- Jun 7, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LMSW17675 | AZ | |
| Clinical Social Worker | 1041C0700X | 17675 | AZ | Primary |
Addresses
Primary practice location
4527 N 16TH St Ste 104
Phoenix, AZ 85016-5353
Mailing address
4527 N 16TH St Ste 104
Phoenix, AZ 85016-5353
Phone (602) 845-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW17675 | AZ | MD | Social Worker |
| 17675 | AZ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559865600000",
"number": "1336708833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4527 N 16TH ST STE 104",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850165353",
"telephone_number": "602-845-8000",
"fax_number": "602-845-8001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4527 N 16TH ST STE 104",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850165353",
"telephone_number": "602-845-8000",
"fax_number": "602-845-8001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "CHRISTINE",
"middle_name": "L",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-07",
"last_updated": "2019-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "AZ",
"license": "LMSW17675",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "17675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.