MEDICARE: REBECCA MARIE LANE-RAMSEY

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	LSW - 809	CO

General Provider Information

NPI Number	:	1578829511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MARIE LANE-RAMSEY

Provider Business Mailing Address
First Line	:	4851 INDEPENDENCE STREET
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-6715
Country	:	US
Telephone Number	:	720-470-4522
Fax Number	:

Provider Business Practice Location Address
First Line	:	7878 WADSWORTH BLVD STE 100
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80003-2121
Country	:	US
Telephone Number	:	303-425-0300
Fax Number	:	303-432-5071

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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