Provider Demographics
NPI:1891714697
Name:ISRAEL, JOAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:ISRAEL
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 1:7200 CATHEDRAL ROCK DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0438
Mailing Address - Country:US
Mailing Address - Phone:702-804-6686
Mailing Address - Fax:702-341-9587
Practice Address - Street 1:7200 CATHEDRAL ROCK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0438
Practice Address - Country:US
Practice Address - Phone:702-804-6686
Practice Address - Fax:702-341-9587
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00120-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV80IAAMedicare PIN