Provider Demographics
NPI:1922389402
Name:WIEGAND, MARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:WIEGAND
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 1:2543 SERENE MOON DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-1565
Mailing Address - Country:US
Mailing Address - Phone:702-334-5928
Mailing Address - Fax:
Practice Address - Street 1:2543 SERENE MOON DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-1565
Practice Address - Country:US
Practice Address - Phone:702-334-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5199-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical