MEDICARE: SHOSHANA ORT LCSW

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	44SC05862200	NJ
2	1041C0700X	Clinical Social Worker	09926088	CO

General Provider Information

NPI Number	:	1821469651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOSHANA ORT LCSW

Provider Business Mailing Address
First Line	:	1344 VRAIN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-1127
Country	:	US
Telephone Number	:	720-775-7149
Fax Number	:

Provider Business Practice Location Address
First Line	:	1344 VRAIN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-1127
Country	:	US
Telephone Number	:	720-775-7149
Fax Number	:

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

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	08/23/2019

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Directions to “ SHOSHANA ORT LCSW” Practice Location

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