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NPI Code Detail

MEDICARE: JESSICA MARIE COLARCO MSW, CSW INTERN

MEDICARE: JESSICA MARIE COLARCO MSW, CSW INTERN
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
11041C0700XClinical Social Worker26475CA
2104100000XSocial Worker6221NV

General Provider Information

NPI Number : 1053450478
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MARIE COLARCO MSW, CSW INTERN
Provider Business Mailing Address
First Line : 1771 QUIVER POINT AVE
Second Line :
City : HENDERSON
State : NV
Zip : 89012-3482
Country : US
Telephone Number : 702-379-6105
Fax Number :
Provider Business Practice Location Address
First Line : 1771 QUIVER POINT AVE
Second Line :
City : HENDERSON
State : NV
Zip : 89012-3482
Country : US
Telephone Number : 702-379-6105
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 04/11/2013

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