Provider Demographics
NPI:1801106844
Name:SOTO, TOMAS G (LBSW-1504)
Entity type:Individual
Prefix:MR
First Name:TOMAS
Middle Name:G
Last Name:SOTO
Suffix:
Gender:M
Credentials:LBSW-1504
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W. UNION ST.
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602
Mailing Address - Country:US
Mailing Address - Phone:520-586-0800
Mailing Address - Fax:520-586-0116
Practice Address - Street 1:611 W. UNION ST.
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602
Practice Address - Country:US
Practice Address - Phone:520-586-0800
Practice Address - Fax:520-586-0116
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLBSW-1504104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker