Provider Demographics
NPI:1821388109
Name:NICOLAS PONZO, LCSW, LTD
Entity Type:Organization
Organization Name:NICOLAS PONZO, LCSW, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MED
Authorized Official - Phone:702-248-1169
Mailing Address - Street 1:10161 PARK RUN DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8871
Mailing Address - Country:US
Mailing Address - Phone:702-248-1169
Mailing Address - Fax:
Practice Address - Street 1:10161 PARK RUN DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8871
Practice Address - Country:US
Practice Address - Phone:702-248-1169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01258C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty