Healthcare Provider Details

I. General information

NPI: 1073161626
Provider Name (Legal Business Name): NICHOLAS L NEUBAUER LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 SUNRISE MEADOWS DR
LAS VEGAS NV
89134-6926
US

IV. Provider business mailing address

2313 SUNRISE MEADOWS DR
LAS VEGAS NV
89134-6926
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS NEUBAUER
Title or Position: OWNER
Credential: LCSW
Phone: 702-806-5268