MEDICARE: VALERIE TINES-BRAGGS 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	2764-C	NV

General Provider Information

NPI Number	:	1568584332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE TINES-BRAGGS MSW LCSW

Provider Business Mailing Address
First Line	:	5940 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2506
Country	:	US
Telephone Number	:	702-203-1964
Fax Number	:	702-446-0100

Provider Business Practice Location Address
First Line	:	5940 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2506
Country	:	US
Telephone Number	:	702-203-1964
Fax Number	:	702-446-0100

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	12/11/2018

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