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General NPI Number Information
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NPI Number | 1558671982
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Entity Type | Individual
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Provider Name | DOMINICK CARL ANTHONY LASORSA MS, LADC
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Gender | Male
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 480 GALLETTI WAY
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City | SPARKS
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State | NV
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Zip | 89431-5564
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Country | US
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Telephone | 775-688-2001
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Fax | 775-688-2004
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Provider Business Mailing Address
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Address Line | 480 GALLETTI WAY
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City | SPARKS
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State | NV
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Zip | 89431-5564
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Country | US
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Telephone | 775-688-2001
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Fax | 775-688-2004
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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 | 2255R0406X
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Taxonomy Name | Blind Rehabilitation Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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