Provider Demographics
NPI:1942816129
Name:DEBRA G. WALDMAN, LMSW, LCSW
Entity Type:Organization
Organization Name:DEBRA G. WALDMAN, LMSW, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-503-8576
Mailing Address - Street 1:PO BOX 34601
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-4601
Mailing Address - Country:US
Mailing Address - Phone:702-277-9426
Mailing Address - Fax:702-795-4141
Practice Address - Street 1:410 S RAMPART BLVD STE 390
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5749
Practice Address - Country:US
Practice Address - Phone:124-879-7371
Practice Address - Fax:702-795-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty