Basic Information
| Provider Information | |||||||||
| NPI: | 1447536123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARANO | ||||||||
| FirstName: | MARISA | ||||||||
| MiddleName: | ILENE | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1398 MINUET ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890526456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024374673 | ||||||||
| FaxNumber: | 7022635310 | ||||||||
| Practice Location | |||||||||
| Address1: | 3450 TANTO CIR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891215047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023714685 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2011 | ||||||||
| LastUpdateDate: | 05/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 6115-S | NV | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 1041C0700X | 6580-C | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.