Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6982-C | NV |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1336439264 |
---|---|
Provider Name | Cassandra Diaz |
First Address | Las Vegas, NV 89183-8514 |
Second Address | Las Vegas, NV 89183-8514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2011 |
Last Update Date | 25/11/2019 |