Healthcare Provider Details

I. General information

NPI: 1063015949
Provider Name (Legal Business Name): KASIA CALDWELL, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S RANCHO DR STE E3A
LAS VEGAS NV
89106-3812
US

IV. Provider business mailing address

801 S RANCHO DR STE E3A
LAS VEGAS NV
89106-3812
US

V. Phone/Fax

Practice location:
  • Phone: 702-620-9354
  • Fax: 702-819-9516
Mailing address:
  • Phone: 702-620-9354
  • Fax: 702-819-9516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KASIA CALDWELL
Title or Position: CEO
Credential: LCSW
Phone: 702-620-9354