=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922420488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY BRENNAN-VERTUCCI PHD,MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2014
-----------------------------------------------------
Last Update Date | 01/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3651 LINDELL RD STE I
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89103-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-529-0358
-----------------------------------------------------
Fax | 866-499-2117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3651 LINDELL RD STE I
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89103-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-529-0358
-----------------------------------------------------
Fax | 866-499-2117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 0380
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------