MEDICARE: MARISA ILENE MARANO L.C.S.W.

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	103K00000X	Behavior Analyst	6115-S	NV
2	1041C0700X	Clinical Social Worker	6580-C	NV

General Provider Information

NPI Number	:	1447536123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA ILENE MARANO L.C.S.W.

Provider Business Mailing Address
First Line	:	1398 MINUET ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-6456
Country	:	US
Telephone Number	:	702-437-4673
Fax Number	:	702-263-5310

Provider Business Practice Location Address
First Line	:	3450 TANTO CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5047
Country	:	US
Telephone Number	:	702-371-4685
Fax Number	:

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

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	05/13/2022

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