Healthcare Provider Details

I. General information

NPI: 1366838997
Provider Name (Legal Business Name): LADWANA RETIC, LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 MCLEOD DR STE 100
LAS VEGAS NV
89120-4445
US

IV. Provider business mailing address

6260 MCLEOD DR STE 100
LAS VEGAS NV
89120-4445
US

V. Phone/Fax

Practice location:
  • Phone: 702-350-1930
  • Fax:
Mailing address:
  • Phone: 702-350-1930
  • Fax:

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 Code251B00000X
TaxonomyCase Management Agency
License Number5976-C
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5976-C
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number5976-C
License Number StateNV

VIII. Authorized Official

Name: LADWANA RETIC
Title or Position: OWNER
Credential: LCSW
Phone: 702-350-1930