MEDICARE: KATHERINE ANN MOLDOVAN L.C.S.W.

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	4474-C	NV

General Provider Information

NPI Number	:	1578634192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANN MOLDOVAN L.C.S.W.

Provider Business Mailing Address
First Line	:	2820 W CHARLESTON BLVD
Second Line	:	#C23
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1942
Country	:	US
Telephone Number	:	702-437-4673
Fax Number	:	702-438-4673

Provider Business Practice Location Address
First Line	:	2820 W CHARLESTON BLVD
Second Line	:	#C23
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1942
Country	:	US
Telephone Number	:	702-437-4673
Fax Number	:	702-438-4673

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	01/19/2013

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