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NPI Code Detail

MEDICARE: MR. SCOTT R PETERSEN LCSW, CADC, CAC-III

MEDICARE: MR. SCOTT R PETERSEN LCSW, CADC, CAC-III
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
11041C0700XClinical Social Worker149010898IL
21041C0700XClinical Social Worker1566CO

General Provider Information

NPI Number : 1386758183
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SCOTT R PETERSEN LCSW, CADC, CAC-III
Provider Business Mailing Address
First Line : PO BOX 201630
Second Line :
City : DENVER
State : CO
Zip : 80220-7630
Country : US
Telephone Number : 312-515-3090
Fax Number :
Provider Business Practice Location Address
First Line : 2111 CHAMPA ST
Second Line :
City : DENVER
State : CO
Zip : 80205-2529
Country : US
Telephone Number : 303-312-9588
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 03/05/2012

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Directions to “ MR. SCOTT R PETERSEN LCSW, CADC, CAC-III” Practice Location

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