Marysol Rezanov, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6215-C Issued in NV

Practice address

4170 S Decatur Blvd Ste C1
Las Vegas, NV 89103-5863

Phone

(702) 659-8827

Fax

(702) 852-0984

NPI assigned

Jun 30, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Marysol Amezcua Former name

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

May accept Medicare assignment

Group practices

Nueva Vida Mental Health LLCGroup PAC ID 3678702701, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nueva Vida Mental Health LLC

  • Clinical Social Worker
  • Las Vegas, NV
  • NPI 1598015240
  Medicare reassignment Care Compare group NPD Authorized official
• Healthcare Partners Medical Group (Coats) LTD.

  • Pediatrics Physician
  • Las Vegas, NV
  • NPI 1902883341
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508112000000",
    "number": "1003127499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4170 S DECATUR BLVD STE C1",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891035863",
            "telephone_number": "702-659-8827",
            "fax_number": "702-852-0984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 S DECATUR BLVD STE C1",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891035863",
            "telephone_number": "702-659-8827",
            "fax_number": "702-852-0984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZANOV",
        "first_name": "MARYSOL",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-30",
        "last_updated": "2017-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "6215-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1598015240",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYSOL",
            "last_name": "AMEZCUA",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Norma Reza
• Rosa Liliana Reza
• Ghazaleh Rezaei, DMD
• Marjan Rezaei
• Zhila Rezaeidehbidi
• Noura Rezapour
• Marcio Rezende
• Ariel Nessen Rezentes, RN
• Ilya Reznikov, PHARMD
• Kristine Amanda Rezny

• Clinical Social Worker in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.