MEDICARE: ROSELLA MARIE REDD 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	251S00000X	Community/Behavioral Health Agency	2003576593	NV

General Provider Information

NPI Number	:	1063704948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELLA MARIE REDD LCSW

Provider Business Mailing Address
First Line	:	1070 W HORIZON RIDGE PKWY STE 210
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-6020
Country	:	US
Telephone Number	:	702-405-0904
Fax Number	:	702-405-0924

Provider Business Practice Location Address
First Line	:	1070 W HORIZON RIDGE PKWY STE 210
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-6020
Country	:	US
Telephone Number	:	702-405-0904
Fax Number	:

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

Provider Enumeration Date	:	05/10/2011
Last Update Date	:	02/11/2021

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