MEDICARE: MS. MYRNA DOLORES MORALES LBSW, MSW

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	2679-S	NV

General Provider Information

NPI Number	:	1558434456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MYRNA DOLORES MORALES LBSW, MSW

Provider Business Mailing Address
First Line	:	4660 S EASTERN AVE
Second Line	:	STE. 201A
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6137
Country	:	US
Telephone Number	:	702-339-0569
Fax Number	:	702-450-4239

Provider Business Practice Location Address
First Line	:	4660 S EASTERN AVE STE 201A
Second Line	:	6171 W. CHARLESTON BLVD. BLDG 16
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6139
Country	:	US
Telephone Number	:	702-486-6138
Fax Number	:	702-486-8029

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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