MEDICARE: MANDY HALL 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	5539-C	NV

General Provider Information

NPI Number	:	1437218203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY HALL LCSW

Provider Business Mailing Address
First Line	:	2661 PINION PINE DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-2346
Country	:	US
Telephone Number	:	775-315-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2661 PINION PINE DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-2346
Country	:	US
Telephone Number	:	775-315-2200
Fax Number	:

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	11/29/2017

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