Healthcare Provider Details

I. General information

NPI: 1265661946
Provider Name (Legal Business Name): NICHOLAS L NEUBAUER M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 MCLEOD DR SUITE #5
LAS VEGAS NV
89120-4405
US

IV. Provider business mailing address

2313 SUNRISE MEADOWS DR
LAS VEGAS NV
89134-6926
US

V. Phone/Fax

Practice location:
  • Phone: 702-898-5311
  • Fax: 702-222-3275
Mailing address:
  • Phone: 702-806-5268
  • Fax: 702-222-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: