Provider Demographics
NPI:1619716669
Name:DAMAVANDI, YASAMIN (LMSW)
Entity type:Individual
Prefix:
First Name:YASAMIN
Middle Name:
Last Name:DAMAVANDI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90550
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89009-0550
Mailing Address - Country:US
Mailing Address - Phone:702-956-2256
Mailing Address - Fax:
Practice Address - Street 1:4029 DEAN MARTIN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4138
Practice Address - Country:US
Practice Address - Phone:702-848-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11430-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker