Provider Demographics
NPI:1932502069
Name:AGATON, GIDEON ALBERTO JR (MSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:GIDEON
Middle Name:ALBERTO
Last Name:AGATON
Suffix:JR
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2980 S RAINBOW BLVD STE 210C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6531
Mailing Address - Country:US
Mailing Address - Phone:702-673-7462
Mailing Address - Fax:702-442-8900
Practice Address - Street 1:2980 S. RAINBOW STE #210C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-673-7462
Practice Address - Fax:702-442-8900
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV104100000X
NV9130-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker