Basic Information
| Provider Information | |||||||||
| NPI: | 1932502069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGATON | ||||||||
| FirstName: | GIDEON | ||||||||
| MiddleName: | ALBERTO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2980 S RAINBOW BLVD STE 210C | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891466531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026737462 | ||||||||
| FaxNumber: | 7024428900 | ||||||||
| Practice Location | |||||||||
| Address1: | 2980 S. RAINBOW STE #210C | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026737462 | ||||||||
| FaxNumber: | 7024428900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2014 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | NV | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 9130-S | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.