Provider Demographics
NPI:1194250126
Name:SHERA, MARTINA PILAR (MSW)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:PILAR
Last Name:SHERA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 DUMONT BLVD
Mailing Address - Street 2:APT 148
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-4266
Mailing Address - Country:US
Mailing Address - Phone:312-213-3215
Mailing Address - Fax:
Practice Address - Street 1:1001 DUMONT BLVD
Practice Address - Street 2:APT 148
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-4266
Practice Address - Country:US
Practice Address - Phone:312-213-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV145600645Medicaid