MEDICARE: LATOYIA KURBANE GRIFFIN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW020251	PA
2	1041C0700X	Clinical Social Worker	0707391	NY
3	1041C0700X	Clinical Social Worker	5085C	NV

General Provider Information

NPI Number	:	1013014976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYIA KURBANE GRIFFIN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 82251
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89180-2251
Country	:	US
Telephone Number	:	702-485-0430
Fax Number	:

Provider Business Practice Location Address
First Line	:	3375 S RAINBOW BLVD UNIT 82251
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89180-8908
Country	:	US
Telephone Number	:	702-485-0430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/21/2022

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