Healthcare Provider Details

I. General information

NPI: 1578634192
Provider Name (Legal Business Name): KATHERINE ANN MOLDOVAN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 W CHARLESTON BLVD #C23
LAS VEGAS NV
89102-1942
US

IV. Provider business mailing address

2820 W CHARLESTON BLVD #C23
LAS VEGAS NV
89102-1942
US

V. Phone/Fax

Practice location:
  • Phone: 702-437-4673
  • Fax: 702-438-4673
Mailing address:
  • Phone: 702-437-4673
  • Fax: 702-438-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4474-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: