MEDICARE: SERAPH DARK 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	11911-C	NV

General Provider Information

NPI Number	:	1841916319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERAPH DARK LCSW

Provider Business Mailing Address
First Line	:	1050 WHITNEY RANCH DR APT 2124
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-2547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 WHITNEY RANCH DR APT 2124
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-2547
Country	:	US
Telephone Number	:	725-900-0224
Fax Number	:

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

Provider Enumeration Date	:	10/17/2022
Last Update Date	:	03/26/2026

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