MEDICARE: ADAM KILIONA VERANO

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	103TP2701X	Group Psychotherapy Psychologist	NV20171708172	NV

General Provider Information

NPI Number	:	1114424744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM KILIONA VERANO

Provider Business Mailing Address
First Line	:	2626 S RAINBOW BLVD STE 203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5190
Country	:	US
Telephone Number	:	702-818-3666
Fax Number	:	702-405-9250

Provider Business Practice Location Address
First Line	:	2626 S RAINBOW BLVD STE 203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5190
Country	:	US
Telephone Number	:	702-818-3666
Fax Number	:	702-405-9250

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

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/10/2018

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