MEDICARE: RICKEY L PERRY MSW

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	2651-C	NV

General Provider Information

NPI Number	:	1073728721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKEY L PERRY MSW

Provider Business Mailing Address
First Line	:	4455 ALLEN LN, SUITE 3
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2229
Country	:	US
Telephone Number	:	702-385-1072
Fax Number	:	702-385-3053

Provider Business Practice Location Address
First Line	:	4455 ALLEN LN, SUITE 3
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2229
Country	:	US
Telephone Number	:	702-385-1072
Fax Number	:	702-385-3053

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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