Individual
TRACEY TAKETA FUGAZZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
7455 W WASHINGTON AVE, #480, LAS VEGAS, NV 89128-4337
(702) 889-5525
Mailing address
7455 W WASHINGTON AVE, #480, LAS VEGAS, NV 89128-4337
(702) 889-5525
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4113-C
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE
NV
Enumeration date
08/18/2006
Last updated
07/08/2007
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