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NPI Code Detail

MEDICARE: KURT DIETER LCSW

MEDICARE:   KURT  DIETER  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 Worker4795-CNV

General Provider Information

NPI Number : 1831276443
Entity Type Code : Individual
Provider Name (Legal Business Name) : KURT DIETER LCSW
Provider Business Mailing Address
First Line : 705 JACOBS LADDER PL
Second Line :
City : LAS VEGAS
State : NV
Zip : 89138-7540
Country : US
Telephone Number : 702-371-0180
Fax Number :
Provider Business Practice Location Address
First Line : 6284 SOUTH RAINBOW BOULEVARD # 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-3245
Country : US
Telephone Number : 702-371-0180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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Directions to “ KURT DIETER LCSW” Practice Location

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