MEDICARE: DR. MARY MONROE PSY.D.

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	103T00000X	Psychologist	2680	CO

General Provider Information

NPI Number	:	1275908907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY MONROE PSY.D.

Provider Business Mailing Address
First Line	:	1750 N LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 N LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1117
Country	:	US
Telephone Number	:	303-587-8779
Fax Number	:

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

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	12/07/2015

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