MEDICARE: MARY BRENNAN-VERTUCCI PHD,MFT

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	106H00000X	Marriage & Family Therapist	0380	NV

General Provider Information

NPI Number	:	1922420488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BRENNAN-VERTUCCI PHD,MFT

Provider Business Mailing Address
First Line	:	3651 LINDELL RD STE I
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1200
Country	:	US
Telephone Number	:	702-529-0358
Fax Number	:	866-499-2117

Provider Business Practice Location Address
First Line	:	3651 LINDELL RD STE I
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1200
Country	:	US
Telephone Number	:	702-529-0358
Fax Number	:	866-499-2117

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

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	01/16/2014

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