MEDICARE: TARAH SHEA SOCKERSON

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	104100000X	Social Worker	1401093061	NV

General Provider Information

NPI Number	:	1457722654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARAH SHEA SOCKERSON

Provider Business Mailing Address
First Line	:	2600 S TOWN CENTER DR
Second Line	:	#2118
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2064
Country	:	US
Telephone Number	:	702-750-4197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S TOWN CENTER DR
Second Line	:	#2118
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2064
Country	:	US
Telephone Number	:	702-750-4197
Fax Number	:

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

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/13/2015

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