Provider Demographics
NPI:1831490259
Name:WARREN, CORTNEY SODERLIND (PHD)
Entity Type:Individual
Prefix:DR
First Name:CORTNEY
Middle Name:SODERLIND
Last Name:WARREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CORTNEY
Other - Middle Name:
Other - Last Name:FISHKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:800 CANYON GREENS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0836
Mailing Address - Country:US
Mailing Address - Phone:979-676-3737
Mailing Address - Fax:
Practice Address - Street 1:800 N RAINBOW BLVD
Practice Address - Street 2:SUITE 170
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1189
Practice Address - Country:US
Practice Address - Phone:702-410-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPSYCH ASSISTANTMedicaid