Provider Demographics
NPI:1356712772
Name:COMENZO, MAURIE S (PHD, LPC, ABCAC)
Entity type:Individual
Prefix:DR
First Name:MAURIE
Middle Name:S
Last Name:COMENZO
Suffix:
Gender:F
Credentials:PHD, LPC, ABCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3039 W. PEORIA AVE.
Mailing Address - Street 2:SUITE #C-102-164
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:602-332-6115
Mailing Address - Fax:602-393-3082
Practice Address - Street 1:11024 NORTH 28TH DRIVE/SUITE #200
Practice Address - Street 2:LAKE BILTMORE CORPORATE CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-332-6115
Practice Address - Fax:602-393-3082
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health