MEDICARE: MANDY MARESSA-YAMAMOTO 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	11728-C	NV

General Provider Information

NPI Number	:	1578296471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY MARESSA-YAMAMOTO LCSW

Provider Business Mailing Address
First Line	:	1452 W. HORIZON RIDGE PKWY
Second Line	:	#106
City	:	HENDERSON
State	:	NV
Zip	:	89012-4480
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1452 W. HORIZON RIDGE PKWY
Second Line	:	#106
City	:	HENDERSON
State	:	NV
Zip	:	89012-4480
Country	:	US
Telephone Number	:	702-882-5162
Fax Number	:

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

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	09/17/2024

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