Basic Information
| Provider Information | |||||||||
| NPI: | 1083254536 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NODAL | ||||||||
| FirstName: | JANNETH | ||||||||
| MiddleName: | MARLENE | ||||||||
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| Credential: | LSW, CSW INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 543 N LAMB BLVD TRLR 37 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891103333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023588816 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2980 S RAINBOW BLVD # 210D | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891466531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026737462 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2020 | ||||||||
| LastUpdateDate: | 01/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | IC-1513 | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.