Provider Demographics
NPI:1033767298
Name:CANEDO, NICOLE (CSWI)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CANEDO
Suffix:
Gender:F
Credentials:CSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 HIMALAYAS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8053
Mailing Address - Country:US
Mailing Address - Phone:702-250-0917
Mailing Address - Fax:
Practice Address - Street 1:2575 MONTESSOURI ST STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3060
Practice Address - Country:US
Practice Address - Phone:702-485-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7827-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker