MEDICARE: REBECCA A. SUGAR LCSW, LAC

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.009927943	CO

General Provider Information

NPI Number	:	1194446534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA A. SUGAR LCSW, LAC

Provider Business Mailing Address
First Line	:	2435 FISH CREEK RD
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-6905
Country	:	US
Telephone Number	:	303-503-7456
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 STANLEY AVE STE 202
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-6356
Country	:	US
Telephone Number	:	970-586-2343
Fax Number	:

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

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	11/30/2022

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