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General NPI Number Information
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NPI Number | 1417200767
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Entity Type | Individual
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Provider Name | MIGUEL ANGEL CORZO LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 2500 CHANDLER AVE STE 3
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City | LAS VEGAS
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State | NV
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Zip | 89120-4064
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Country | US
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Telephone | 725-204-8809
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Fax |
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Provider Business Mailing Address
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Address Line | 6254 ANGORA PEAK LN
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City | LAS VEGAS
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State | NV
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Zip | 89115-1662
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | IC-1930
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 9426-M
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11385-C
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License Number State | NV
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