Healthcare Provider Details

I. General information

NPI: 1265625800
Provider Name (Legal Business Name): PAMELA GOODFRIEND, LCSW, CAC III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 W. 84TH WAY
ARVADA CO
80003
US

IV. Provider business mailing address

6505 W. 84TH WAY
ARVADA CO
80003
US

V. Phone/Fax

Practice location:
  • Phone: 303-269-1191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number575
License Number StateCO

VIII. Authorized Official

Name: PAMELA GOODFRIEND
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential:
Phone: 303-269-1191