| Doctor Name: | BERNADETTE MARISCAL |
| NPI Number: | 1457613481 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LAC, NCC |
| License Number: | LAC-13757 |
| Business Practice Address: | 5418 E Skyline Dr Building 1 San Tan Valley, AZ - 851409000 |
| Business Phone Number: | 6023265379 |
| Business Fax Number: | |
| Mailing Address: | 270 E Hunt Hwy, Suite 16, Pbm # 144 SAN TAN VALLEY |
| State: | AZ |
| Postal Code: | 851434962 |
| Phone Number: | 6023265379 |
| Fax Number: | |
| NPI Enumeration Date: | 06/14/2012 |
| NPI Last Update Date: | 06/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LAC-13757 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |