MEDICARE: ERICKA N PAEZ 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	1041C0700X	Clinical Social Worker	114412	CA
2	1041C0700X	Clinical Social Worker	10720-C	NV
3	1041C0700X	Clinical Social Worker	0904018033	VA

General Provider Information

NPI Number	:	1306435672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA N PAEZ LCSW

Provider Business Mailing Address
First Line	:	79553 HALF MOON BAY DR
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-0963
Country	:	US
Telephone Number	:	951-692-2739
Fax Number	:

Provider Business Practice Location Address
First Line	:	9085 CAMP LIGHT AVE UNIT 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3154
Country	:	US
Telephone Number	:	760-470-4069
Fax Number	:

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

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	03/20/2026

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Directions to “ ERICKA N PAEZ LCSW” Practice Location

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