MEDICARE: MS. AISHIA GREVENBERG 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	104100000X	Social Worker	4661-S	NV
2	1041C0700X	Clinical Social Worker	6121-C	NV
3	1041S0200X	School Social Worker	6121-C	NV

General Provider Information

NPI Number	:	1851535520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AISHIA GREVENBERG LCSW

Provider Business Mailing Address
First Line	:	33 DELIGHTED AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1393
Country	:	US
Telephone Number	:	702-523-5226
Fax Number	:	702-834-4871

Provider Business Practice Location Address
First Line	:	5154 S DURANGO DR
Second Line	:	STE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3171
Country	:	US
Telephone Number	:	702-523-5226
Fax Number	:	702-834-4871

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

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	06/04/2013

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