MEDICARE: DOMIANO-SADER THERAPY LLC.

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11890842	OTHER	NV	CAQH

General Provider Information

NPI Number	:	1710252275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMIANO-SADER THERAPY LLC.

Provider Business Mailing Address
First Line	:	9550 S EASTERN AVE
Second Line	:	SUITE 220
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8038
Country	:	US
Telephone Number	:	702-945-1600
Fax Number	:	702-451-9157

Provider Business Practice Location Address
First Line	:	9550 S EASTERN AVE
Second Line	:	SUITE 220
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8038
Country	:	US
Telephone Number	:	702-292-8711
Fax Number	:	702-451-9157

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	NANCY DOMIANO-SADER
Credential	:	LCSW, LADC
Telephone Number	:	702-945-1600

Provider Enumeration Date	:	03/16/2012
Last Update Date	:	05/11/2016

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