Provider Demographics
NPI:1063719813
Name:FICALORA, DANIEL PAUL (MA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PAUL
Last Name:FICALORA
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 ALTA DR STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4165
Mailing Address - Country:US
Mailing Address - Phone:702-474-6450
Mailing Address - Fax:702-474-6563
Practice Address - Street 1:4221 MCLEOD DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5215
Practice Address - Country:US
Practice Address - Phone:702-474-6450
Practice Address - Fax:702-474-6450
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0044I-LC101YA0400X
NVCP0106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100525881Medicaid