Active NPI
Demetria Collins
- Clinical Social Worker
- Las Vegas, NV
National Provider Identifier
1699181289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- IC-1138
- Practice address
- 4000 E Charleston Blvd Ste 130
Las Vegas, NV 89104-6681 - Phone
- (702) 968-5059
- NPI assigned
- Jul 3, 2014
- Sex
- Female
- Sole proprietor
- Yes
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-1138 | NV | Primary |
Addresses
Primary practice location
4000 E Charleston Blvd Ste 130
Las Vegas, NV 89104-6681
Mailing address
1401 N Michael Way Apt 148
Las Vegas, NV 89108-1460
Phone (702) 480-1031
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8665-C | Other | NV | STATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS |
| IC-1138 | Other | NV | STATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS |
| 6876-S | Other | NV | STATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS |
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-1138 | NV | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576022400000",
"number": "1699181289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 N MICHAEL WAY APT 148",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891081460",
"telephone_number": "702-480-1031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 E CHARLESTON BLVD STE 130",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891046681",
"telephone_number": "702-968-5059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLINS",
"first_name": "DEMETRIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-03",
"last_updated": "2019-12-11",
"certification_date": "2019-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NV",
"license": "IC-1138",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS",
"identifier": "8665-C",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS",
"identifier": "IC-1138",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF NEVADA BOARD OF EXAMINERS FOR SOCIAL WORKERS",
"identifier": "6876-S",
"state": "NV"
}
],
"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 Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.