Provider Demographics
NPI:1194880674
Name:RADDATZ, ALAN PAUL (MSW,BCD)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:PAUL
Last Name:RADDATZ
Suffix:
Gender:M
Credentials:MSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 OBANNON DR STE 190
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2158
Mailing Address - Country:US
Mailing Address - Phone:702-320-3180
Mailing Address - Fax:702-320-3180
Practice Address - Street 1:6960 OBANNON DR STE 190
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-320-3180
Practice Address - Fax:702-320-3180
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSNV LCSW 00131-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194880674Medicaid
NVLADC0772LOtherLICENSED DRUG AND ALCOHOL
NV1041C0700XOtherLCSW