Provider Demographics
NPI:1821259078
Name:SERRANO, EDITH E
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:E
Last Name:SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 S DURANGO DR
Mailing Address - Street 2:#2042
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-203-1395
Mailing Address - Fax:
Practice Address - Street 1:2750 S DURANGO DR
Practice Address - Street 2:APT 2042
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2644
Practice Address - Country:US
Practice Address - Phone:702-203-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor