Provider Demographics
NPI:1801306238
Name:MAPLETHORPE, STEFAINE (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:STEFAINE
Middle Name:
Last Name:MAPLETHORPE
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:STEFAINE
Other - Middle Name:
Other - Last Name:MAPLETHORPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3321 N BUFFALO DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129
Mailing Address - Country:US
Mailing Address - Phone:702-515-1373
Mailing Address - Fax:702-331-3098
Practice Address - Street 1:3321 N BUFFALO DRIVE
Practice Address - Street 2:SUITE 125
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129
Practice Address - Country:US
Practice Address - Phone:702-515-1373
Practice Address - Fax:702-331-3098
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV204-L101YA0400X
NV5430-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)