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General NPI Number Information
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NPI Number | 1629319918
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Entity Type | Organization
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Legal Business Name | CENTENNIAL PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 03/12/2013
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 7495 W AZURE DR STE 205
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City | LAS VEGAS
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State | NV
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Zip | 89130-4416
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Country | US
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Telephone | 702-608-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 7495 W AZURE DR STE 205
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City | LAS VEGAS
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State | NV
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Zip | 89130-4416
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Country | US
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Telephone | 702-608-0404
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | NICOLE PUCCI
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Credential | L.C.S.W.
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Telephone | 702-278-8911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6050-C
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License Number State | NV
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