Provider Demographics
NPI:1013209238
Name:REA, GEORGENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GEORGENE
Middle Name:
Last Name:REA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89125-0149
Mailing Address - Country:US
Mailing Address - Phone:702-813-7757
Mailing Address - Fax:
Practice Address - Street 1:45 AVENIDA ARENAS
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6352
Practice Address - Country:US
Practice Address - Phone:702-813-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4721-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical