MEDICARE: VALERIE DIMICK 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	4737-C	NV

General Provider Information

NPI Number	:	1821230228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE DIMICK MSW-LCSW

Provider Business Mailing Address
First Line	:	4825 E CAREY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-5510
Country	:	US
Telephone Number	:	702-353-0826
Fax Number	:	702-642-3879

Provider Business Practice Location Address
First Line	:	4825 E CAREY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-5510
Country	:	US
Telephone Number	:	702-353-0826
Fax Number	:	702-642-3879

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

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	03/31/2009

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