Provider Demographics
NPI:1710255427
Name:AUKUSITINO, MYRA H (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:H
Last Name:AUKUSITINO
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VITA FRESCO CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-3156
Mailing Address - Country:US
Mailing Address - Phone:702-810-7242
Mailing Address - Fax:702-441-5542
Practice Address - Street 1:1 VITA FRESCO CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-3156
Practice Address - Country:US
Practice Address - Phone:702-810-7242
Practice Address - Fax:702-441-5542
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6096S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110973OtherBIRTHDATE