MEDICARE: MRS. NANCY LEAH CALDWELL 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	4688-C	NV

General Provider Information

NPI Number	:	1609945047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY LEAH CALDWELL LCSW

Provider Business Mailing Address
First Line	:	7741 SIERRA PASEO LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-2756
Country	:	US
Telephone Number	:	702-838-4328
Fax Number	:

Provider Business Practice Location Address
First Line	:	6171 W CHARLESTON BLVD # 15
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1126
Country	:	US
Telephone Number	:	702-486-0003
Fax Number	:	702-455-8902

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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