Provider Demographics
NPI:1013638840
Name:BAUTISTA, CECILIA (LMSW, CSW INTERN)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:LMSW, CSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 CASCADE VALLEY CT STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0481
Mailing Address - Country:US
Mailing Address - Phone:702-240-8639
Mailing Address - Fax:
Practice Address - Street 1:7180 CASCADE VALLEY CT STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0481
Practice Address - Country:US
Practice Address - Phone:702-240-8639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner