MEDICARE: VALERIE DIMICK INSTITUTE LLC

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

General Provider Information

NPI Number	:	1891339149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALERIE DIMICK INSTITUTE LLC

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	:

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	:	OWNER/MANAGER
Name	:	VALERIE SCHMIDTLEIN DIMICK
Credential	:	MSW-LCSW
Telephone Number	:	702-642-0040

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	12/16/2019

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