MEDICARE: FOSTER SOURCE

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

General Provider Information

NPI Number	:	1316777386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOSTER SOURCE

Provider Business Mailing Address
First Line	:	3879 E 120TH AVE # 218
Second Line	:
City	:	THORNTON
State	:	CO
Zip	:	80233-1658
Country	:	US
Telephone Number	:	303-618-4331
Fax Number	:

Provider Business Practice Location Address
First Line	:	11860 PECOS ST RM 1131
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-2740
Country	:	US
Telephone Number	:	303-618-4331
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MS. KATHRYN S SMITH
Credential	:	LCSW
Telephone Number	:	720-979-9033

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/15/2024

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Directions to “FOSTER SOURCE ” Practice Location

Language	Start Address	Practice Location

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