Provider Demographics
NPI:1538506951
Name:LASA, JOELLE GUTMAN (MSW)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:GUTMAN
Last Name:LASA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 GRAMERCY LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4635
Mailing Address - Country:US
Mailing Address - Phone:775-787-9411
Mailing Address - Fax:775-787-9445
Practice Address - Street 1:3700 SAFE HARBOR WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1137
Practice Address - Country:US
Practice Address - Phone:775-787-9411
Practice Address - Fax:775-787-9445
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6359-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker