Provider Demographics
NPI:1679780225
Name:DOMIANO-SADER, NANCY (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DOMIANO-SADER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:L
Other - Last Name:SADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9550 S EASTERN AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-8045
Mailing Address - Country:US
Mailing Address - Phone:702-945-1600
Mailing Address - Fax:702-463-3031
Practice Address - Street 1:9550 S EASTERN AVE
Practice Address - Street 2:SUITE 220 - B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-8038
Practice Address - Country:US
Practice Address - Phone:702-292-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4818C102L00000X, 1041C0700X
NV986L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1679780225Medicaid