Provider Demographics
NPI:1013094457
Name:EARL, GERALD R (MSSW)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:R
Last Name:EARL
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9409 ROLLING RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0150
Mailing Address - Country:US
Mailing Address - Phone:702-360-0445
Mailing Address - Fax:702-360-0445
Practice Address - Street 1:3131 LA CANADA ST STE 216
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2579
Practice Address - Country:US
Practice Address - Phone:702-636-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01219-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical