Provider Demographics
NPI:1417456005
Name:MARILYN STRADA PHD LLC
Entity Type:Organization
Organization Name:MARILYN STRADA PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRADA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-635-6555
Mailing Address - Street 1:8565 S EASTERN AVE STE 152
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2906
Mailing Address - Country:US
Mailing Address - Phone:702-635-6555
Mailing Address - Fax:562-478-4575
Practice Address - Street 1:8565 S EASTERN AVE STE 152
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2906
Practice Address - Country:US
Practice Address - Phone:562-274-8203
Practice Address - Fax:562-478-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPYO811103G00000X, 103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty