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NPI Code Detail

MEDICARE: MRS. GARNETTE DAWN MCCRACKEN L.C.S.W.

MEDICARE: MRS. GARNETTE DAWN MCCRACKEN L.C.S.W.
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 Worker4944-CNV

General Provider Information

NPI Number : 1063466498
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GARNETTE DAWN MCCRACKEN L.C.S.W.
Provider Business Mailing Address
First Line : 6375 W CHARLESTON BLVD
Second Line : A-100
City : LAS VEGAS
State : NV
Zip : 89146-1139
Country : US
Telephone Number : 702-253-0818
Fax Number : 702-253-9625
Provider Business Practice Location Address
First Line : 6375 W CHARLESTON BLVD
Second Line : A-100
City : LAS VEGAS
State : NV
Zip : 89146-1139
Country : US
Telephone Number : 702-253-0818
Fax Number : 702-253-9625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 02/22/2010

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