Provider Demographics
NPI:1811451164
Name:GOMEZ CUADRO, VANESSA ENID (LSW)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ENID
Last Name:GOMEZ CUADRO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 CLASSIC VILLA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1699
Mailing Address - Country:US
Mailing Address - Phone:939-969-3491
Mailing Address - Fax:
Practice Address - Street 1:8325 CLASSIC VILLA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1699
Practice Address - Country:US
Practice Address - Phone:939-969-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8161-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker