MEDICARE: AMANDA MICHELLE PARTIN MSW, 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	IC-1121	NV
2	104100000X	Social Worker	7526-S	NV
3	1041C0700X	Clinical Social Worker	8531-C	NV

General Provider Information

NPI Number	:	1447623574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MICHELLE PARTIN MSW, LCSW

Provider Business Mailing Address
First Line	:	8685 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2839
Country	:	US
Telephone Number	:	865-964-8561
Fax Number	:

Provider Business Practice Location Address
First Line	:	8685 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2839
Country	:	US
Telephone Number	:	865-964-8561
Fax Number	:

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

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	08/19/2019

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