Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 7806-S | NV |
Y | 1041C0700X | Clinical Social Worker | 9077-C | NV |
NPI | 1003116146 |
---|---|
Provider Name | Glenda E Cruz Juarez |
First Address | Las Vegas, NV 89103-5863 |
Second Address | Las Vegas, NV 89103-5863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2010 |
Last Update Date | 14/09/2021 |