MEDICARE: LARISSA MARY MARCEAU LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW.09932896	CO

General Provider Information

NPI Number	:	1053091082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISSA MARY MARCEAU LCSW

Provider Business Mailing Address
First Line	:	7887 E BELLEVIEW AVE STE 1100
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80111-6097
Country	:	US
Telephone Number	:	406-890-8431
Fax Number	:

Provider Business Practice Location Address
First Line	:	10455 E 25TH AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80010-1207
Country	:	US
Telephone Number	:	406-890-8431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	03/02/2026

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