1801027586 NPI number — DEBRA MARCUS DOODKEVITCH LCSW, ACSW

Table of content: DEBRA MARCUS DOODKEVITCH LCSW, ACSW (NPI 1801027586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801027586 NPI number — DEBRA MARCUS DOODKEVITCH LCSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOODKEVITCH
Provider First Name:
DEBRA
Provider Middle Name:
MARCUS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARCUS
Provider Other First Name:
DEBRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801027586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5530 KINGS ROW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89148-4658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-219-5046
Provider Business Mailing Address Fax Number:
702-442-7190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 SPRING MOUNTAIN RD
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-8823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-228-8236
Provider Business Practice Location Address Fax Number:
702-442-7190
Provider Enumeration Date:
07/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  5682-C , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 247200000X , with the licence number: CNTH#200510 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 5557-N , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCS8748 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)