Active NPI
Statia Marie Cermak
- Clinical Social Worker
- Las Vegas, NV
National Provider Identifier
1386350478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- IC-2916
- Practice address
- 5412 Boulder Hwy
Las Vegas, NV 89122-6039 - Phone
- (702) 291-7121
- Fax
- (702) 507-2534
- NPI assigned
- Jan 23, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | IC-2916 | NV | Primary |
Addresses
Primary practice location
5412 Boulder Hwy
Las Vegas, NV 89122-6039
Mailing address
5412 Boulder Hwy
Las Vegas, NV 89122-6039
Phone (702) 291-7121
Other practice location 1
315 Record St Ste 100
Reno, NV 89512-3327
Phone (775) 405-4111
Other practice location 2
850 Mill St Ste 100
Reno, NV 89502-1463
Phone (775) 538-6700
Other practice location 3
3312 W Charleston Blvd
Las Vegas, NV 89102-1829
Phone (702) 971-2300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IC-2916 | NV | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773792000000",
"number": "1386350478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5412 BOULDER HWY",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891226039",
"telephone_number": "702-291-7121",
"fax_number": "702-507-2534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5412 BOULDER HWY",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891226039",
"telephone_number": "702-291-7121",
"fax_number": "702-507-2534"
}
],
"practiceLocations": [
{
"address_1": "315 Record St Ste 100",
"address_purpose": "LOCATION",
"city": "Reno",
"state": "NV",
"postal_code": "895123327",
"country_code": "US",
"telephone_number": "775-405-4111",
"fax_number": "775-688-5878",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "850 Mill St Ste 100",
"address_purpose": "LOCATION",
"city": "Reno",
"state": "NV",
"postal_code": "895021463",
"country_code": "US",
"telephone_number": "775-538-6700",
"fax_number": "775-688-5878",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3312 W Charleston Blvd",
"address_purpose": "LOCATION",
"city": "Las Vegas",
"state": "NV",
"postal_code": "891021829",
"country_code": "US",
"telephone_number": "702-971-2300",
"fax_number": "702-903-4447",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CERMAK",
"first_name": "STATIA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-23",
"last_updated": "2026-03-18",
"certification_date": "2026-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NV",
"license": "IC-2916",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.