MEDICARE: MRS. MAGEENA ELISHEVA TOM LMSW

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	104100000X	Social Worker	6378S	NV

General Provider Information

NPI Number	:	1073858585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAGEENA ELISHEVA TOM LMSW

Provider Business Mailing Address
First Line	:	222 S RAINBOW BLVD
Second Line	:	#205
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5340
Country	:	US
Telephone Number	:	702-487-3154
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S RAINBOW BLVD
Second Line	:	#205
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5340
Country	:	US
Telephone Number	:	702-487-3154
Fax Number	:

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

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	09/17/2013

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