Provider Demographics
NPI:1386939908
Name:MORITA, NICHOLLETTE MIYOKO (LCSW)
Entity type:Individual
Prefix:
First Name:NICHOLLETTE
Middle Name:MIYOKO
Last Name:MORITA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICHOLLETTE
Other - Middle Name:
Other - Last Name:MORITA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6900 N PECOS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-4400
Mailing Address - Country:US
Mailing Address - Phone:702-791-9000
Mailing Address - Fax:702-791-9836
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:702-791-9386
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7308-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPSR-H2017Medicaid