Provider Demographics
NPI:1356490684
Name:POBLETE, PATRICIA C (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:POBLETE
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 1:1930 VILLAGE CENTER CIR # 3239
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6299
Mailing Address - Country:US
Mailing Address - Phone:510-224-0103
Mailing Address - Fax:
Practice Address - Street 1:1809 SNOW SPRING LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-2551
Practice Address - Country:US
Practice Address - Phone:725-270-7759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276021041C0700X
NV8784-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27602OtherBBS
NV8784-COtherSTATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS