MEDICARE: LISA RAE KORSLIN MSW & 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	101Y00000X	Counselor	15337	WI
2	1041C0700X	Clinical Social Worker	1303123	WI
3	1041C0700X	Clinical Social Worker	9199-C	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265606123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RAE KORSLIN MSW & LCSW

Provider Business Mailing Address
First Line	:	5509 GHOST RIDER CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-2064
Country	:	US
Telephone Number	:	920-242-8586
Fax Number	:

Provider Business Practice Location Address
First Line	:	5509 GHOST RIDER CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-2064
Country	:	US
Telephone Number	:	920-242-8586
Fax Number	:

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	06/07/2024

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