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NPI Code Detail

MEDICARE: STATIA MARIE CERMAK

MEDICARE: STATIA MARIE CERMAK
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
11041C0700XClinical Social WorkerIC-2916NV

General Provider Information

NPI Number : 1386350478
Entity Type Code : Individual
Provider Name (Legal Business Name) : STATIA MARIE CERMAK
Provider Business Mailing Address
First Line : 5412 BOULDER HWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89122-6039
Country : US
Telephone Number : 702-291-7121
Fax Number : 702-507-2534
Provider Business Practice Location Address
First Line : 5412 BOULDER HWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89122-6039
Country : US
Telephone Number : 702-291-7121
Fax Number : 702-507-2534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2023
Last Update Date : 03/18/2026

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Directions to “ STATIA MARIE CERMAK ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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