Healthcare Provider Details

I. General information

NPI: 1427483304
Provider Name (Legal Business Name): CHARLOTTE LOCKHART MARGULIES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MAIN ST STE 200
ASPEN CO
81611-1787
US

IV. Provider business mailing address

120 E MAIN ST STE 200
ASPEN CO
81611-1787
US

V. Phone/Fax

Practice location:
  • Phone: 970-432-8492
  • Fax:
Mailing address:
  • Phone: 970-432-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925061
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier84-0406820
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: