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NPI Code Detail

MEDICARE: JENNIFER RENIA GAYAN LCSW

MEDICARE: JENNIFER RENIA GAYAN 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
11041C0700XClinical Social Worker5883-CNV

General Provider Information

NPI Number : 1578718706
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER RENIA GAYAN LCSW
Provider Business Mailing Address
First Line : 9163 W FLAMINGO RD STE 120
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6458
Country : US
Telephone Number : 702-530-3051
Fax Number :
Provider Business Practice Location Address
First Line : 9163 W FLAMINGO RD STE 120
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6458
Country : US
Telephone Number : 702-530-3051
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2008
Last Update Date : 03/25/2011

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