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NPI Code Detail

MEDICARE: MS. RACHEL PETERSON LCSW

MEDICARE: MS. RACHEL PETERSON 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
11041C0700XClinical Social Worker7864-CNV

General Provider Information

NPI Number : 1396110284
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RACHEL PETERSON LCSW
Provider Business Mailing Address
First Line : 4625 W NEVSO DR STE 2
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-3763
Country : US
Telephone Number : 702-300-2759
Fax Number :
Provider Business Practice Location Address
First Line : 1513 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-3916
Country : US
Telephone Number : 702-703-5537
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2015
Last Update Date : 05/26/2021

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