Provider Demographics
NPI:1578296471
Name:MARESSA-YAMAMOTO, MANDY (LCSW)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:MARESSA-YAMAMOTO
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 1:1452 W. HORIZON RIDGE PKWY
Mailing Address - Street 2:#106
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1452 W. HORIZON RIDGE PKWY
Practice Address - Street 2:#106
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4480
Practice Address - Country:US
Practice Address - Phone:702-882-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11728-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical