Healthcare Provider Details

I. General information

NPI: 1023665437
Provider Name (Legal Business Name): JUDITH UNGAR NEUENKIRCH MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5426 VEGAS DR
LAS VEGAS NV
89108-2403
US

IV. Provider business mailing address

7261 SANDY PLAINS AVE
LAS VEGAS NV
89131-3387
US

V. Phone/Fax

Practice location:
  • Phone: 702-806-5268
  • Fax: 702-485-1107
Mailing address:
  • Phone: 702-497-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8763-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: