MEDICARE: MRS. LISA S DUBIN 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	7371-C	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467505677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA S DUBIN LCSW

Provider Business Mailing Address
First Line	:	4700 LAS VEGAS BLVD NORTH
Second Line	:	NELLIS AFB HOSPITAL
City	:	LAS VEGAS
State	:	NV
Zip	:	89014
Country	:	US
Telephone Number	:	347-920-1420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1231
Country	:	US
Telephone Number	:	347-920-1420
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	11/01/2018

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