=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942910898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAYLEY MATTIO CSW-I
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2022
-----------------------------------------------------
Last Update Date | 01/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 E TROPICANA AVE # 580
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-6517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-898-5311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 736 JEWEL TOWER ST
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89178-1218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-767-5809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 7046-M
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------