Provider Demographics
NPI:1891183141
Name:JEREMIAH, MARIAH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:JEREMIAH
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 1:5940 S RAINBOW BLVD STE 400
Mailing Address - Street 2:PMB 81116
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-7382
Mailing Address - Country:US
Mailing Address - Phone:775-375-5734
Mailing Address - Fax:775-376-9315
Practice Address - Street 1:5940 S RAINBOW BLVD STE 400
Practice Address - Street 2:PMB 81116
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-8911
Practice Address - Country:US
Practice Address - Phone:775-375-5734
Practice Address - Fax:775-376-9315
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7453-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical