Individual
MRS. MARYSOL REZANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4170 S DECATUR BLVD STE C1, LAS VEGAS, NV 89103-5863
(702) 659-8827
(702) 852-0984
Mailing address
4170 S DECATUR BLVD STE C1, LAS VEGAS, NV 89103-5863
(702) 659-8827
(702) 852-0984
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6215-C
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598015240
GROUP NPI
NV
Enumeration date
06/30/2010
Last updated
10/16/2017
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