Provider Demographics
NPI:1053610741
Name:AFFUSO, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:AFFUSO
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 1:13460 N 94TH DR STE M1
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4247
Mailing Address - Country:US
Mailing Address - Phone:623-974-3333
Mailing Address - Fax:623-974-3390
Practice Address - Street 1:13460 N 94TH DR STE M1
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4247
Practice Address - Country:US
Practice Address - Phone:623-974-3333
Practice Address - Fax:623-974-3390
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker