MEDICARE: TIARA MARIE NEUBAUER

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		NV

General Provider Information

NPI Number	:	1609211259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIARA MARIE NEUBAUER

Provider Business Mailing Address
First Line	:	308 LAKEHURST RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5231
Country	:	US
Telephone Number	:	702-207-9358
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 S JONES BLVD STE 230
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5394
Country	:	US
Telephone Number	:	702-776-5061
Fax Number	:

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

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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