Provider Demographics
NPI:1740573880
Name:HERETAKIS, FRANCINE MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:FRANCINE
Middle Name:MARIE
Last Name:HERETAKIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 S DURANGO DR STE 179
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0155
Mailing Address - Country:US
Mailing Address - Phone:702-285-7987
Mailing Address - Fax:
Practice Address - Street 1:4955 S DURANGO DR STE 179
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0155
Practice Address - Country:US
Practice Address - Phone:702-285-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11829777-35011041C0700X
NV2501-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1740573880Medicaid
NVPTAN: FE214AMedicare UPIN