Provider Demographics
NPI:1851535520
Name:GREVENBERG, AISHIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AISHIA
Middle Name:
Last Name:GREVENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DELIGHTED AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1393
Mailing Address - Country:US
Mailing Address - Phone:702-523-5226
Mailing Address - Fax:702-834-4871
Practice Address - Street 1:5154 S DURANGO DR
Practice Address - Street 2:STE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3171
Practice Address - Country:US
Practice Address - Phone:702-523-5226
Practice Address - Fax:702-834-4871
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4661-S104100000X
NV6121-C1041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool