MEDICARE: DR. JEFFREY REZNICEK-PARRADO PH.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	103TC1900X	Counseling Psychologist	PSY4818	CO
2	103TC1900X	Counseling Psychologist	PSY27790	CA

General Provider Information

NPI Number	:	1396278024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY REZNICEK-PARRADO PH.D.

Provider Business Mailing Address
First Line	:	950 MAGNOLIA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-4717
Country	:	US
Telephone Number	:	530-746-8319
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 MAGNOLIA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-4717
Country	:	US
Telephone Number	:	530-746-8319
Fax Number	:

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

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	08/25/2021

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