MEDICARE: PATRICIA C POBLETE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	27602	CA
2	1041C0700X	Clinical Social Worker	8784-C	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27602	OTHER	CA	BBS
2	8784-C	OTHER	NV	STATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS

General Provider Information

NPI Number	:	1356490684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA C POBLETE LCSW

Provider Business Mailing Address
First Line	:	1930 VILLAGE CENTER CIR # 3239
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6299
Country	:	US
Telephone Number	:	510-224-0103
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 SNOW SPRING LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-2551
Country	:	US
Telephone Number	:	725-270-7759
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	10/22/2022

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Directions to “ PATRICIA C POBLETE LCSW” Practice Location

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