MEDICARE: MS. DANIELLE P CARRON MS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1831302595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE P CARRON MS

Provider Business Mailing Address
First Line	:	4785 HANCOCK DR
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-1103
Country	:	US
Telephone Number	:	303-359-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2833 NORTH BROADWAY
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303
Country	:	US
Telephone Number	:	303-449-2217
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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