Individual
LANCE CORY DEVERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8406 S 49TH LN, LAVEEN, AZ 85339-2159
(215) 678-7702
Mailing address
8406 S 49TH LN, LAVEEN, AZ 85339-2159
(215) 678-7702
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/17/2021
Last updated
09/17/2021
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