Provider Demographics
NPI:1730193343
Name:RUSICH, JANIE ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANIE
Middle Name:ELIZABETH
Last Name:RUSICH
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 1:6900 N. PECOS RD
Mailing Address - Street 2:RENAL CLINIC
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:702-224-6971
Practice Address - Street 1:6900 N. PECOS RD
Practice Address - Street 2:RENAL CLINIC
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:702-224-6971
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR063281-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical