Provider Demographics
NPI:1154980225
Name:CRAM, LEAH MARIN (LCSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIN
Last Name:CRAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 TOM NOON AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-6700
Mailing Address - Country:US
Mailing Address - Phone:503-550-2373
Mailing Address - Fax:
Practice Address - Street 1:1601 E BASIN AVE STE 303
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-4612
Practice Address - Country:US
Practice Address - Phone:775-537-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8414-S104100000X
NV99941-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1154980225Medicaid