Provider Demographics
NPI:1497028682
Name:FUIMAONO, DEJA RACHELLE ETHEL (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEJA
Middle Name:RACHELLE ETHEL
Last Name:FUIMAONO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:DEJA
Other - Middle Name:RACHELLE ETHEL
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8321 BELLO CIRCONDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8257
Mailing Address - Country:US
Mailing Address - Phone:702-350-1898
Mailing Address - Fax:
Practice Address - Street 1:570 W CHEYENNE AVE STE 190
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3983
Practice Address - Country:US
Practice Address - Phone:702-350-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253J00000X
NV8661-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV14927028682Medicaid
NV1497028682Medicaid