Provider Demographics
NPI:1114183217
Name:ITHURRALDE, BERTRAND ANDRE (MSW)
Entity Type:Individual
Prefix:MR
First Name:BERTRAND
Middle Name:ANDRE
Last Name:ITHURRALDE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 S MCCARRAN BLVD BLDG 6
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6165
Mailing Address - Country:US
Mailing Address - Phone:775-448-9760
Mailing Address - Fax:
Practice Address - Street 1:6490 S MCCARRAN BLVD BLDG 6
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6165
Practice Address - Country:US
Practice Address - Phone:775-448-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-16521041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator