Provider Demographics
NPI:1073858585
Name:TOM, MAGEENA ELISHEVA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MAGEENA
Middle Name:ELISHEVA
Last Name:TOM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S RAINBOW BLVD
Mailing Address - Street 2:#205
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5340
Mailing Address - Country:US
Mailing Address - Phone:702-487-3154
Mailing Address - Fax:
Practice Address - Street 1:222 S RAINBOW BLVD
Practice Address - Street 2:#205
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5340
Practice Address - Country:US
Practice Address - Phone:702-487-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6378S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker