Provider Demographics
NPI:1972166213
Name:TROTTA, MARY JACQUELINE (BA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JACQUELINE
Last Name:TROTTA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CARACAS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0135
Mailing Address - Country:US
Mailing Address - Phone:702-381-2723
Mailing Address - Fax:
Practice Address - Street 1:229 CARACAS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0135
Practice Address - Country:US
Practice Address - Phone:702-381-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health